RESUMO Introdução: A doença renal crônica (DRC) está associada à disbiose intestinal, inflamação sistêmica e comprometimento da função da barreira intestinal. A zonulina sérica tem sido proposta como um marcador indireto da permeabilidade intestinal, embora sua relevância clínica na DRC permaneça incerta. Objetivo: Avaliar o efeito da suplementação com probióticos nos níveis séricos de zonulina em pacientes submetidos à hemodiálise de manutenção. Métodos: Ensaio clínico randomizado, controlado por placebo e triplo-cego, no qual 40 pacientes em hemodiálise foram designados para receber uma formulação probiótica ou placebo durante seis meses. O desfecho primário foi a diferença entre os grupos na alteração dos níveis séricos de zonulina do início ao acompanhamento. Os desfechos secundários incluíram variáveis metabólicas, antropométricas, hemodinâmicas e gastrointestinais. Resultados: Os níveis séricos de zonulina aumentaram em ambos os grupos, sem diferença significativa entre eles (placebo: 288,2 a 425,3 ng/mL; probiótico: 239,5 a 453,7 ng/mL; p = 0,882; ANCOVA p = 0,463). A ureia pré-diálise diminuiu no grupo probiótico, mas a diferença entre os grupos não foi significativa (p = 0,305). O fósforo sérico apresentou uma redução maior no grupo probiótico do que no grupo placebo (p = 0,011; ANCOVA p = 0,011). Não foram observadas diferenças significativas nos desfechos antropométricos ou hemodinâmicos. Conclusão: Seis meses de suplementação com probióticos não reduziram significativamente os níveis séricos de zonulina em pacientes em hemodiálise. Embora tenha sido observado um efeito favorável sobre o fósforo sérico, esses resultados não comprovam um impacto mensurável desse regime probiótico sobre a zonulina sérica, e sinalizam a necessidade de estudos maiores que incorporem avaliações diretas da permeabilidade intestinal e da microbiota intestinal.
Coal-fired thermoelectric plants remain important for dispatchable electricity generation and supply stability, but their dependence on fossil carbon results in high greenhouse gas emissions. This study evaluated pilot-scale batch pyrolysis of green coconut husk pellets for biochar production and its incorporation into bituminous coal blends as a potential route for partial fossil-coal substitution. Pyrolysis experiments were performed in a pilot-scale pyrolysis unit using 40 kg of pellets at final temperatures of 400 and 500 °C. The products were characterized by proximate analysis, higher heating value (HHV), non-condensable gas composition, and mass and energy balances. Coal–BIO400 blends were prepared with biochar produced at 400 °C (BIO400) at 1, 5, 10, and 20 wt% and characterized for proximate, elemental, inorganic, morphological, surface elemental, and energetic properties. Pyrolysis at 400 °C favored biochar production, with a yield of 34.13%, compared with 28.05% at 500 °C. Although the 500 °C condition increased non-condensable gas yield from 15.93% to 22.57%, the 400 °C condition showed a significantly higher recoverable product-energy ratio, while no statistically significant differences were detected in gross product-energy recovery ratio or biochar energy between the two conditions. BIO400 showed low moisture content, high fixed carbon content, and an HHV of 27.42 MJ·kg⁻¹, corresponding to 96.7% of the bituminous coal HHV. The coal–BIO400 blends retained HHV values of 28.25–28.44 MJ·kg⁻¹, and no statistically significant differences in HHV were detected among BIO400, bituminous coal, and the coal–BIO400 blends under the reported analytical conditions. These results support the evaluation of green coconut husk biochar as a potential component for partial fossil-coal substitution, although combustion, emission, ash behavior, boiler compatibility, and life-cycle assessments are still required.
Abstract Introduction: Chronic kidney disease (CKD) is associated with intestinal dysbiosis, systemic inflammation, and impaired intestinal barrier function. Serum zonulin has been proposed as an indirect marker of intestinal permeability, although its clinical relevance in CKD remains uncertain. Objective: To evaluate the effect of probiotic supplementation on serum zonulin levels in patients undergoing maintenance hemodialysis. Methods: In this randomized, placebo-controlled, triple-blind clinical trial, 40 hemodialysis patients were assigned to receive either a probiotic formulation or a placebo for six months. The primary outcome was the between-group difference in change in serum zonulin from baseline to follow-up. Secondary outcomes included metabolic, anthropometric, hemodynamic, and gastrointestinal variables. Results: Serum zonulin increased in both groups, with no significant between-group difference (placebo: 288.2 to 425.3 ng/mL; probiotic: 239.5 to 453.7 ng/mL; p = 0.882; ANCOVA p = 0.463). Pre-dialysis urea decreased within the probiotic group, but the between-group difference was not significant (p = 0.305). Serum phosphorus showed a greater reduction in the probiotic group than in the placebo group (p = 0.011; ANCOVA p = 0.011). No significant differences were observed for anthropometric or hemodynamic outcomes. Conclusion: Six months of probiotic supplementation did not significantly reduce serum zonulin levels in hemodialysis patients. Although a favorable effect on serum phosphoruswas observed, these findings do not support a measurable impact of this probiotic regimen on serum zonulin and highlight the need for larger studies incorporating direct assessments of intestinal permeability and gut microbiota.
Abstract Background Hopkins syndrome (HS) is a rare neuromuscular disorder characterized by poliomyelitis-like flaccid paralysis occurring in children after an acute asthma attack. This report describes the multimodal neurophysiological and ultrasonographic evaluation of a child presenting with post-asthmatic lower limb weakness and discusses the differential diagnosis of flaccid paralysis in childhood. Case presentation A 2-year-old boy presented with left leg weakness two weeks after an asthma exacerbation; one month after symptom onset, he was unable to walk without assistance. The child’s past medical history was significant only for asthma, and his vaccination schedule, including for poliomyelitis, was up to date. Neurological examination revealed left lower limb weakness with areflexia (absent reflexes) and moderate atrophy. Electroneuromyography and muscle ultrasound indicated a chronic, asymmetric anterior horn cell disease without evidence of acute denervation. Conclusion HS is a rare neuromuscular disorder characterized by poliomyelitis-like paralysis that occurs in children following an acute asthma attack. Given its rarity, the pathophysiology and optimal management strategies for HS remain poorly understood. A multimodal assessment combining ultrasound and neurophysiological studies is valuable for improving the characterization of this phenotype.
OBJECTIVES:This study aimed to compare the diagnostic accuracy of dental specialists when assessing endodontic and periodontal lesions using periapical radiography (PR) alone and PR combined with cone-beam computed tomography (PR+CBCT). METHODS:In this cross-sectional study, 30 endodontists and 30 periodontists evaluated ten clinical cases involving endodontic and periodontal tissues at two time points. The cases included vertical root fractures/fissures, endodontic perforation, persistent apical periodontitis, concomitant endo-periodontal injury, and localized periodontitis. Initially, participants reviewed clinical data and periapical radiographs for each case, formulating a diagnostic hypothesis via a structured questionnaire. Subsequently, CBCT images were introduced, and participants reassessed the images and reached a diagnosis again. The correct diagnosis, as established by the dentist responsible for each case, was included as one of the answer choices. Diagnostic accuracy for overall and specific lesion types after incorporating CBCT was analyzed using the McNemar test, with statistical significance set at 5%. RESULTS:The overall percentage of correct diagnoses was 67.2% for PR+CBCT and 42.2% for PR. PR+CBCT provided accurate diagnoses in 58.8% of cases for both specialties. Regarding lesion type, PR+CBCT correctly identified a greater number of endo-periodontal lesions with and without root damage compared to PR alone. CONCLUSIONS:PR+CBCT significantly improves diagnostic accuracy for both endodontists and periodontists in cases involving both pulp and periodontal tissues.
