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Background The time course of blood lactate levels could be helpful to assess a patient’s response to therapy. Although the focus of published studies has been largely on septic patients, many other studies have reported serial blood lactate levels in different groups of acutely ill patients. Methods We performed a systematic search of PubMed, Science Direct, and Embase until the end of February 2016 plus reference lists of relevant publications. We selected all observational and interventional studies that evaluated the capacity of serial blood lactate concentrations to predict outcome. There was no restriction based on language. We excluded studies in pediatric populations, experimental studies, and studies that did not report changes in lactate values or all-cause mortality rates. We separated studies according to the type of patients included. We collected data on the number of patients, timing of lactate measurements, minimum lactate level needed for inclusion if present, and suggested time interval for predictive use. Results A total of 96 studies met our criteria: 14 in general ICU populations, five in general surgical ICU populations, five in patients post cardiac surgery, 14 in trauma patients, 39 in patients with sepsis, four in patients with cardiogenic shock, eight in patients after cardiac arrest, three in patients with respiratory failure, and four in other conditions. A decrease in lactate levels over time was consistently associated with lower mortality rates in all subgroups of patients. Most studies reported changes over 6, 12 or 24 hrs, fewer used shorter time intervals. Lactate kinetics did not appear very different in patients with sepsis and other types of patients. A few studies suggested that therapy could be guided by these measurements. Conclusions The observation of a better outcome associated with decreasing blood lactate concentrations was consistent throughout the clinical studies, and was not limited to septic patients. In all groups, the changes are relatively slow, so that lactate measurements every 1–2 hrs are probably sufficient in most acute conditions. The value of lactate kinetics appears to be valid regardless of the initial value.

The need for mechanical ventilation is one of the main concerns related to the care of patients with COVID-19. The aim of this study is to evaluate the efficacy of a bubble device for oxygen supplementation. This device was implemented for the selected patients hospitalized with severe COVID-19 pneumonia with persistent low oxygen saturation. Patients were selected in three major COVID-19 hospitals of Bahia state in Brazil from July to November 2020, where they remained with the device for seven days and were monitored for different factors, such as vital signs, oximetry evaluation, and arterial blood gasometry. Among the 51 patients included in the study, 68.63% successfully overcame hypoxemia without the necessity to be transferred to mechanical ventilation, whereas 31.37% required tracheal intubation (p value < 0.05). There was no difference of note on the analysis of the clinical data, chemistry, and hematological evaluation, with the exception of the SpO2 on follow-up days. Multivariate analysis revealed that the independent variable, male sex, SpO2, and non-inhaled mask, was associated with the necessity of requiring early mechanical ventilation. We concluded that this bubble device should be a prior step to be utilized before indication of mechanical ventilation in patients with persistent hypoxemia of severe COVID-19 pneumonia.

Abstract This work sought to evaluate the impact of the expansion of tourism in the consumer habits of the small community of Coronel Xavier Chaves, in the state of Minas Gerais. It initially carried out a qualitative study to identify attributes considered relevant, and related to the overall response: the impact of tourism on consumer habits of a small community. Based on this initial investigation, a survey was carried out with a sample of 98 residents of the town, to verify the culture of the local society and the processes of change established after the expansion of the local tourism activity. The Lúcio Couto Rennó; Dalton Jorge T Teixeira eixeira - O impacto do turismo nos hábitos de consumo de uma comunidade de pequeno porte data collected were analyzed using techniques of descriptive statistics, with numerical and tabular synthesis of the information collected in the study. Based on the answers given, it can be observed that from the point of view of the inhabitants of the town, tourism has changed the reality of the small cities, influencing the consumer habits and transforming the culture of the community of Coronel Xavier Chaves in a positive way. Key words: Receptive tourism; marketing; consumer behavior.

(1) Background: Gastric cancer patients are known to be at a high risk of malnutrition, sarcopenia, and cachexia, and the latter impairs the patient’s nutritional status during their clinical course and also treatment response. A clearer identification of nutrition-related critical points during neoadjuvant treatment for gastric cancer is relevant to managing patient care and predicting clinical outcomes. The aim of this systematic review was to identify and describe nutrition-related critical domains associated with clinical outcomes. (2) Methods: We performed a systematic review (PROSPERO ID:CRD42021266760); (3) Results: This review included 14 studies compiled into three critical domains: patient-related, clinical-related (disease and treatment), and healthcare-related. Body composition changes during neoadjuvant chemotherapy (NAC) accounted for the early termination of chemotherapy and reduced overall survival. Sarcopenia was confirmed to have an independent prognostic value. The role of nutritional interventions during NAC has not been fully explored. (4) Conclusions: Understanding critical domain exposures affecting nutritional status will enable better clinical approaches to optimize care plans. It may also provide an opportunity for the mitigation of poor nutritional status and sarcopenia and their deleterious clinical consequences.

Eucalypts are susceptible to a wide range of diseases. One of the most important diseases that affect Eucalyptus plantations worldwide is caused by the rust fungus Puccinia psidii . Here, we provide evidence on the complex genetic control of rust resistance in Eucalyptus inter-specific hybrids, by analyzing a number of full-sib families that display different patterns of segregation for rust resistance. These families are totally unrelated to those previously used in other inheritance studies of rust resistance. By using a full genome scan with 114 genetic markers (microsatellites and expressed sequence tag derived microsatellites) we also corroborated the existence and segregation of a resistance locus, explaining 11.5% of the phenotypic variation, on linkage group 3, corresponding to Ppr1 . This find represents an additional validation of this locus in totally unrelated pedigree. We have also detected significant additive × additive digenic interactions with LOD >10.0 on several linkage groups. The additive and epistatic QTLs identified explain between 29.8 and 44.8% of the phenotypic variability for rust resistance. The recognition that both additive and non-additive genetic variation (epistasis) are important contributors to rust resistance in eucalypts reveals the complexity of this host-pathogen interaction and helps explain the success that breeding has achieved by selecting rust-resistant clones, where all the additive and non-additive effects are readily captured. The positioning of epistatic QTLs also provides starting points to look for the underlying genes or genomic regions controlling this phenotype on the upcoming E. grandis genome sequence.

Klebsiella pneumoniae infections pose a great burden worldwide, causing high morbidity and mortality. New therapeutic/prophylactic strategies are urgently needed to overcome antibiotic resistance and reduce the health and economic impacts of diseases caused by this pathogen. Fimbriae are important virulence factors involved in biofilm formation and adhesion to host cells. Their exposed location and conservation among clinical isolates make them interesting candidates for inclusion in protein-based vaccines. Therefore, the present work investigated the immunological potential of K. pneumoniae fimbriae subunits as vaccine candidates. In-silico analysis of the type 1 (FimA and FimH) and type 3 (MrkA and MrkD) fimbrial components showed that all four proteins contain B- and T- cell epitopes predicted to bind into the peptide binding cleft. Additionally, a 7-allele prediction model was used to assess the binding and presentation of these epitopes, with some showing potential for presentation across different class II MHC alleles. The genes encoding fimbriae subunits FimA and MrkA were cloned in prokaryotic vector systems, expressed in E. coli and purified by Ni2+ affinity chromatography. Subcutaneous immunization of mice with recombinant FimA and MrkA using Alum as adjuvant induced specific IgG production. The protective potential of MrkA immunization was tested against challenge with a hypervirulent K. pneumoniae strain; although a modest increase in survival time was observed in the immunized group, all mice died within 5 days of infection. Overall, although the in-silico analysis suggests that K. pneumoniae fimbriae components promising vaccine candidates, protection against highly virulent strains with increased capsule may require additional antigens.

Ceratocystis wilt caused by the fungus Ceratocystis fimbriata , is currently one of the major diseases in commercial plantations of Eucalyptus trees in Brazil. Deployment of resistant genotypes has been the main strategy for effective disease management. The present study aimed at identifying genomic regions underlying the genetic control of resistance to Ceratocystis wilt in Eucalyptus by quantitative trait loci (QTL) mapping in an outbred hybrid progeny derived from a cross between ( Eucalyptus dunnii × Eucalyptus grandis ) × ( Eucalyptus urophylla × Eucalyptus globulus ). A segregating population of 127 individuals was phenotyped for resistance to Ceratocystis wilt using controlled inoculation under a completely randomized design with five clonal replicates per individual plant. The phenotypic resistance response followed a continuous variation, enabling us to analyze the trait in a quantitative manner. The population was genotyped with 114 microsatellite markers and 110 were mapped with an average interval of 12.3 cM. Using a sib-pair interval-mapping approach five QTLs were identified for disease resistance, located on linkage groups 1, 3, 5, 8, and 10, and their estimated individual heritability ranged from 0.096 to 0.342. The QTL on linkage group 3 overlaps with other fungal disease-resistance QTLs mapped earlier and is consistent with the annotation of several disease-resistance genes on this chromosome in the E. grandis genome. This is the first study to identify and attempt to quantify the effects of QTLs associated with resistance to Ceratocystis wilt in Eucalyptus .

Deforestation of riparian areas is a major driver of biodiversity loss in aquatic ecosystems. Thus, we investigated the influence of forest cover and physical and chemical characteristics of streams on zooplankton communities in the southeastern Amazon. We addressed the following questions: (1) Are environmental factors (water physical and chemical characteristics and landscape variables) and dispersive processes (reflected in the spatial structure among sampling sites) efficient predictors of zooplankton communities in different hydrologic seasons? (2) Can zooplankton species be indicators of watersheds’ forest-cover levels? We sampled 15 streams located in nine rural settlements in northern Mato Grosso, Brazil, in the dry (August) and rainy (March) seasons of 2017. The forest-cover level had a significant effect on the physical and chemical characteristics (conductivity, dissolved oxygen, and temperature) of streams and also on the structure and composition of zooplankton communities, mainly of rotifers and testate amoebae. Areas with low vegetation cover had seasonal changes in species richness, individuals density, and zooplankton community structure. Environmental and spatial variables had no significant effect on the structure of zooplankton communities, which may indicate the strong influence of stochastic factors. Species from three zooplankton groups (rotifers, microcrustaceans, and testate amoebae) were indicators of forest-cover classes. This study provided valuable contributions to the conservation of riparian ecosystems and the use of biological indicators in environmental monitoring programs.

Bacterial blight caused by Erwinia psidii is considered an important disease of the guava crop in Brazil. The disease has been disseminated to different geographic areas due to the movement of infected but asymptomatic propagating plant material. Consequently, methods showing high specificity and sensitivity for early detection of latent infections are required to aid in the establishment of the use of pathogen-free seedlings and propagating material. In this study, an intercalating dye-based real-time PCR (qPCR) method using newly designed species-specific primers targeting the recA gene sequence was developed. Primer specificity was first confirmed in silico and then by PCR amplification using DNA from strains of a collection of E. psidii and other plant-associated bacterial species. DNA from strains of other bacterial species obtained from uninfected guava and eucalypt leaves or from other plant species were not amplified. When bacterial suspensions and purified DNA were used in qPCR, detection limits were 10 3  CFU mL −1 and 10 2 genomic units µL −1 , respectively. Using qPCR, E. psidii was detected in 100% of samples from symptomatic and in 57.1% of samples from asymptomatic trees collected in four guava orchards. The qPCR method allowed quantification of E. psidii populations in infected tissue of varieties Pedro Sato and Sassaoka as well as confirmation of the previously reported E. psidii acropetal and basipetal movement inside the plant. This new detection method with improved sensitivity has great potential not only for implementing disease diagnosis in guava and eucalypt nurseries and orchards but also for investigating relevant aspects of E. psidii life cycle and epidemiology.