Major Insect Pests of Sweet Potatoes in Brazil and the United States, with Information on Crop Production and Regulatory Pest Management.

The sweet potato [Ipomoea batatas (L.) Lam] is considered one of the most important crops in the world as food, fodder, and raw material for starch and alcohol production. Sweet potato consumption and demand for its value-added products have increased significantly over the past two decades, leading to new cultivars, expansion in acreage, and increased demand in the United States and its export markets. Due to its health benefits, sweet potato production has multiplied over the past decade in Brazil, promoting food security and economic development in rural areas. Their adaptability and nutritional value make them a food of great importance for Brazil. As pest attacks and disease infection are the main limiting aspects that often cause yield loss and quality degradation in sweet potatoes, there is a great demand to develop effective defense strategies to maintain productivity. There is a critical need for research into non-pesticide control approaches that can provide safe, cost-effective, sustainable, and environmentally friendly pest and disease management techniques. Pests which feed on roots have trade implications worldwide. For example, sweet potato tuber shipments infested with the sweet potato weevil are generally not allowed for trade in North and South America.

Assessment of Brazil's vesicular syndrome surveillance system: Profile of notifications and performance of the official veterinary service.

Foot-and-mouth disease (FMD) is an ailment that causes serious damage to the productive chain, and its control through vaccination is of utmost importance for its eradication. Brazil initiated the National Foot-and-Mouth Disease Surveillance Program (PNEFA) with the aim of making the country FMD-free by 2026. As part of the program, notifications of vesicular lesions became mandatory for the Official Veterinary Service (OVS), which is responsible for verifying them. Due to its size, border areas with countries that do not have FMD-free status pose a risk to Brazil and require greater attention. This study described the profile of notifications of suspected outbreaks of vesicular syndrome in Brazil and analyzed the performance of the surveillance system. The results showed 7134 registered notifications of suspected vesicular syndrome outbreaks from 2018 to 2022, with 2022 having the highest number (n = 2343 or 32.85 %). The species that generated the most notifications were swine (90.99 %), cattle and buffaloes (7.54 %), goats and sheep (1.44 %), and others (0.03 %). The sources of notification were "Veterinary medicine professionals" (61.82 %), "Owners or employees" (13.66 %), "Third parties" (8.90 %), "OVS" (7.20 %), and "others" (2.66 %). 41.69 % of notifications originated from non-border municipalities, and 58.32 % from border areas. Only the state of Paraná account for 51.73 % of the total notifications. This state also accounted for 66.70 % of the 32.47 % of notifications with a final diagnosis of "absence of clinically compatible signs or susceptible animals", indicating a certain lack of knowledge in the area, leading to unnecessary notifications and system overload. The performance of the OVS was evaluated based on the service response time from notification registration trough Logistic and Negative binomial regressions. A total of 27.83 % of notifications did not meet the Brazilian legally specified time, and the zone related to the state of Parana needs improvements in performance. The presence and peaks of Senecavirus A cases may have influenced an increased number of swine notifications and led to a decrease in OVS response time. The results demonstrate better performance of surveillance in border areas. Given the vast territory of Brazil, it is not expected that 100 % of responses occur within the legal timeframe, however, the performance of the surveillance system proved to be adequate, with 86 % complied to the legislation. The performance indicators could be used as a monitoring tool, along with indicators to demonstrate system overload. Continued education actions are crucial for strengthening PNEFA.

Sex dimorphism in pupae and adults of the specialist Ipomoea batatas defoliator Bedellia somnulentella (Lepidoptera: Bedelliidae).

Bedellia somnulentella Zeller, 1847 (Lepidoptera: Bedelliidae), a global pest of the sweet potato Ipomoea batatas, was recorded in Brazil, but morphological information on the sexual dimorphism of this insect is scarce. The objective was to evaluate morphological characters of sexual dimorphism of B. somnulentella pupae and adults. External structures with sexual dimorphism were not detected in the last abdominal segments of B. somnulentella pupae. The females of this insect are heavier, which could be a distinctive sex characteristic. A pair of frenulum on the hind wings of females and only one on those of males, in addition to elongated cerci and bipartite genitalia in the latter and smaller cerci involving the last abdominal segment and an ovipositor in females, differentiate sexes of B. somnulentella.

Neph1 is required for neurite branching and is negatively regulated by the PRRXL1 homeodomain factor in the developing spinal cord dorsal horn.

The cell-adhesion molecule NEPH1 is required for maintaining the structural integrity and function of the glomerulus in the kidneys. In the nervous system of Drosophila and C. elegans, it is involved in synaptogenesis and axon branching, which are essential for establishing functional circuits. In the mammalian nervous system, the expression regulation and function of Neph1 has barely been explored. In this study, we provide a spatiotemporal characterization of Neph1 expression in mouse dorsal root ganglia (DRGs) and spinal cord. After the neurogenic phase, Neph1 is broadly expressed in the DRGs and in their putative targets at the dorsal horn of the spinal cord, comprising both GABAergic and glutamatergic neurons. Interestingly, we found that PRRXL1, a homeodomain transcription factor that is required for proper establishment of the DRG-spinal cord circuit, prevents a premature expression of Neph1 in the superficial laminae of the dorsal spinal cord at E14.5, but has no regulatory effect on the DRGs or on either structure at E16.5. By chromatin immunoprecipitation analysis of the dorsal spinal cord, we identified four PRRXL1-bound regions within the Neph1 introns, suggesting that PRRXL1 directly regulates Neph1 transcription. We also showed that Neph1 is required for branching, especially at distal neurites. Together, our work showed that Prrxl1 prevents the early expression of Neph1 in the superficial dorsal horn, suggesting that Neph1 might function as a downstream effector gene for proper assembly of the DRG-spinal nociceptive circuit.

Investigation of Malocclusion and Associated Factors in Preschoolers: A Cross-Sectional Questionnaire Study.

This study aims to describe the prevalence of malocclusion and identify associated factors in preschool children. Completed in 2022-2023, this cross-sectional study included 523 children aged 26 to 80 months in municipal schools in Salvador. An oral examination was carried out on the children, and a questionnaire was self-administered by the parents. Descriptive analyses and multivariate logistic regression (the backward method, p-value ≤ 0.05, 95% CI) were conducted. The majority of children were female (51.82%), over 54 months old (52.2%), Black or mixed race (90.63%), and not affected by COVID-19 (92.35%). The prevalence of malocclusion was 43.21%, with open bite as the most common condition. There was a significant association between malocclusion and screen time (OR: 1.34; p: 0.116; CI: 1.0-1.94), physical/psychological aggression (OR: 2.55; p: 0.031; CI: 1.0-5.98), consumption of ultra-processed foods (OR: 1.77; p: 0.003; CI: 1.22-2.57), digital suction (OR: 3.1; p: 0.001; CI: 1.56-6.16), and the habit of biting objects (OR: 1.56; p: 0.121; CI: 1.0-2.73). The promotion of comprehensive health in early childhood and psychosocial interventions are recommended, aiming to reduce screen time, aggression, consumption of ultra-processed foods, thumb sucking, and the habit of biting objects to prevent malocclusion.

Estratégias educativas em saúde para pessoas vivendo com HIV: revisão de escopo / Estrategias educativas en salud para personas que viven con el VIH: revisión de alcance / Health educational strategies for people living with HIV: scoping review

Resumo Objetivo Mapear a produção científica sobre as estratégias educativas e os conteúdos abordados na educação de pessoas vivendo com HIV. Métodos Esta é uma revisão de escopo em que a seleção dos artigos foi realizada em abril de 2021 e atualizada em outubro de 2022 em dez fontes de dados; a revisão seguiu os pressupostos estabelecidos pelo Joanna Briggs Institute e o checklist dos Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Os resultados foram analisados descritivamente e sintetizados em um quadro. Resultados Foram selecionados 17 estudos com publicação predominante em 2017; Estados Unidos da América e Brasil foram os países com a maior quantidade de produções. A maioria dos estudos buscou avaliar o impacto e a eficácia das estratégias e desenvolver ou validar instrumentos de educação em saúde e atividades de prevenção. Em relação ao conteúdo abordado pelas estratégias, foram formadas cinco categorias: orientação inicial sobre HIV/AIDS, cuidados gerais, vida saudável, saúde sexual e suporte emocional. As estratégias educativas que se destacaram em relação à maior adesão dos pacientes ao tratamento estão relacionadas com o desenvolvimento de sistemas, programas e multimídia. As cartilhas promoveram empoderamento e autonomia de pessoas vivendo com HIV. Conclusão Foram mapeadas as principais estratégias educativas, com destaque para cartilhas, material impresso, recursos multimídia, sistemas, formulários e oficinas/workshops, abordando orientação inicial sobre HIV/AIDS, tratamento farmacológico, cuidados gerais, vida saudável, saúde sexual e suportes social e emocional.

Resumen Objetivo Mapear la producción científica sobre las estrategias educativas y los contenidos abordados en la educación de personas que viven con el VIH. Métodos Esta es una revisión de alcance, cuya selección de artículos se realizó en abril de 2021 y se actualizó en octubre de 2022 en diez fuentes de datos. La revisión siguió las premisas establecidas por el Joanna Briggs Institute y la checklist de los Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Los resultados fueron analizados descriptivamente y sintetizados en un cuadro. Resultados Se seleccionaron 17 estudios con publicación predominante en 2017. Estados Unidos de América y Brasil fueron los países con mayor cantidad de producciones. La mayoría de los estudios buscó evaluar el impacto y la eficacia de las estrategias y elaborar o validar instrumentos de educación para la salud y actividades de prevención. Con relación al contenido abordado por las estrategias, se formaron cinco categorías: instrucciones iniciales sobre VIH/SIDA, cuidados generales, vida saludable, salud sexual y apoyo emocional. Las estrategias educativas que se destacaron con relación a una mayor adhesión de los pacientes al tratamiento están relacionadas con el desarrollo de sistemas, programas y multimedia. Las cartillas promovieron empoderamiento y autonomía de personas que viven con el VIH. Conclusión Se mapearon las principales estrategias educativas, con énfasis en cartillas, material impreso, recursos multimedia, sistemas, formularios y talleres/workshops, que abordaron instrucciones iniciales sobre VIH/SIDA, tratamiento farmacológico, cuidados generales, vida saludable, salud sexual y apoyo social y emocional. Open Science Framework (OSF): https://osf.io/754uk/?view_only=6491865a3d12424d81af2c4099c112c3

Abstract Objective To map the scientific production on educational strategies and the content covered in the education of people living with HIV. Methods This is a scoping review in which the selection of articles was carried out in April 2021 and updated in October 2022 in ten data sources; the review followed the assumptions established by the Joanna Briggs Institute and the checklist of Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. The results were descriptively analyzed and summarized in a chart. Results A total of 17 studies were selected, predominantly published in 2017; The USA and Brazil were the countries with the largest number of productions. Most studies sought to evaluate the impact and effectiveness of strategies and develop or validate health education instruments and prevention activities. Concerning the content covered by the strategies, five categories were formed: initial guidance on HIV/AIDS, general care, healthy living, sexual health, and emotional support. The educational strategies that stood out concerning greater patient adherence to treatment are related to the development of systems, programs, and multimedia. The booklets promoted empowerment and autonomy for people living with HIV. Conclusion The main educational strategies were mapped, with emphasis on booklets, printed material, multimedia resources, systems, forms, and workshops, covering initial guidance on HIV/AIDS, pharmacological treatment, general care, healthy living, sexual health, and social and emotional support. Open Science Framework (OSF): https://osf.io/754uk/?view_only=6491865a3d12424d81af2c4099c112c3

Improvement in the quality of pressure injury prevention in an intensive care unit / Mejora de la calidad de la prevención de lesiones por presión en una unidad de cuidados intensivos / Melhoria da qualidade da prevenção de lesão por pressão em uma unidade de terapia intensiva

ABSTRACT Objective: to assess the effect of implementing a quality improvement project on the process of pressure injury prevention in an adult Intensive Care Unit. Method: a quality improvement project for the pressure injury prevention process was carried out in an adult Intensive Care Unit of a public hospital from November 2022 to July 2023. It was developed following the steps of an improvement cycle. The quality level of pressure injury prevention was measured before and after the interventions, using six quality criteria. Data collection for the first assessment was conducted in March 2023, retrospectively, referring to November and December 2022 and January 2023. Quality reassessment occurred in July 2023, also retrospectively, referring to April, May, and June 2023. Interventions included changes in records related to assistance in pressure injury prevention and education/awareness of the team on pressure injury prevention. Results: the initial quality assessment showed that the compliance level of pressure injury prevention was low, with virtually all criteria showing rates below 50%. After the interventions, there was an increase in compliance with almost all criteria. Conclusion: the use of a quality improvement project enabled the improvement of the pressure injury prevention process and contributed to the scientific community by corroborating the effectiveness of these projects in implementing pressure injury prevention programs, as well as prompting reflection on the multifactorial nature involved in this preventive process.

RESUMEN Objetivo: evaluar el efecto de la implementación de un proyecto de mejora de la calidad en el proceso de prevención de lesiones por presión en una Unidad de Cuidados Intensivos para adultos. Método: se llevó a cabo un proyecto de mejora de la calidad del proceso de prevención de lesiones por presión en una Unidad de Cuidados Intensivos para adultos de un hospital público, entre noviembre de 2022 y julio de 2023. Este proyecto se desarrolló siguiendo las etapas de un ciclo de mejora. El nivel de calidad en la prevención de lesiones por presión se midió antes y después de las intervenciones, utilizando seis criterios de calidad. La recopilación de datos para la primera evaluación se realizó en marzo de 2023, retrospectivamente, para los meses de noviembre y diciembre de 2022 y enero de 2023. La reevaluación de la calidad se llevó a cabo en julio de 2023, también retrospectivamente, para los meses de abril, mayo y junio de 2023. Las intervenciones incluyeron cambios en los registros relacionados con la asistencia en la prevención de lesiones por presión y la educación/concientización del equipo sobre la prevención de lesiones por presión. Resultados: la evaluación inicial de la calidad mostró que el nivel de conformidad en la prevención de lesiones por presión era bajo, con casi todos los criterios presentando tasas inferiores al 50%. Después de las intervenciones, hubo un aumento en la conformidad en casi todos los criterios. Conclusión: el uso de un proyecto de mejora de la calidad permitió mejorar el proceso de prevención de lesiones por presión y contribuyó con la comunidad científica, al corroborar la eficacia de estos proyectos en la implementación de programas de prevención de lesiones por presión, así como para promover la reflexión sobre los múltiples factores involucrados en este proceso preventivo.

RESUMO Objetivo: Avaliar o efeito da implementação de um projeto de melhoria da qualidade no processo de prevenção de lesão por pressão numa Unidade de Terapia Intensiva adulto. Método: Projeto de melhoria da qualidade do processo de prevenção de lesão por pressão, realizado em uma Unidade de Terapia Intensiva adulto, de um hospital público, no período de novembro/2022 a julho/2023. Foi desenvolvido seguindo as etapas de um ciclo de melhoria. O nível de qualidade da prevenção de lesão por pressão foi medido antes e depois das intervenções, utilizando seis critérios de qualidade. A coleta de dados da primeira avaliação foi realizada em março/2023, de forma retrospectiva, referente aos meses de novembro e dezembro/2022 e janeiro/2023. A reavaliação de qualidade ocorreu em julho de 2023, também de forma retrospectiva, referente aos meses de abril, maio e junho/2023. As intervenções incluíram mudanças nos registros relacionados à assistência na prevenção de LP e educação/sensibilização da equipe sobre prevenção de lesão por pressão. Resultados: A avaliação inicial da qualidade mostrou que o nível de conformidade de prevenção de lesão por pressão era baixo, com praticamente todos os critérios apresentando taxas inferiores a 50%. Após as intervenções, houve aumento na conformidade de quase todos os critérios. Conclusão: A utilização de um projeto de melhoria de qualidade possibilitou a melhora do processo de prevenção de lesão por pressão e contribuiu com a comunidade científica, ao corroborar a eficácia destes projetos na implementação de programas de prevenção lesão por pressão, bem como incitou a reflexão acerca da multifatorialidade envolvida neste processo preventivo.

Cobertura vacinal e taxa de abandono nas capitais do nordeste brasileiro entre 2018 e 2022 / Vaccination coverage and abandonment rate in Northeastern Brazilian capitals between 2018 and 2022 / Cobertura de vacunación y tasa de abandono en las capitales del Noreste Brasileño entre 2018 y 2022

Introdução: O Programa Nacional de Imunizações presente na Atenção Primária à Saúde coordena o processo de imunização e o torna mais eficaz, porém esse sistema enfrenta problemas como a falta de acesso à internet e desabastecimento de imunizantes, que prejudicam a cobertura vacinal da população e dificultam o registro eletrônico dos dados indicadores, além de aumentar a taxa de abandono vacinal. Objetivo:Analisar os indicadores de Cobertura Vacinal e Taxa de Abandono nas capitais do Nordeste nos últimos cinco anos. Metodologia:Estudo epidemiológico, quantitativo e descritivo. As nove capitais do Nordeste do Brasil foram selecionadas para o estudo. A temática abordada é a Taxa de Abandono Vacinal e a Cobertura Vacinal nos últimos cinco anos nas capitais. Os dados foram coletados através doSistema de Informação do Programa Nacional de Imunização e armazenadosno Microsoft Excel. Resultados:Quanto às taxasde cobertura vacinal, Fortaleza teve o maior percentual, com 74,87%. Maceió obteve o segundo maior índice, com 66,12%. Em relação às taxas de abandono vacinal, Salvador registrou o maior número,com 27,39% nos últimos cinco anos. Não obstante, João Pessoaobteve a menor taxa, com 16,08%. Conclusões:Verificou-se que Fortaleza teve a maiorCobertura Vacinal e Salvador teve a maiorTaxa de Abandono Vacinal.Algumas capitais tiveram redução naCobertura Vacinal e aumento na Taxa de Abandono Vacinalno período pandêmico, indicando a necessidade de mais pesquisas sobre o impacto da Covid-19 e a circulação de informações equivocadas sobre vacinação. Logo, a atuação da atenção primária à saúde é crucial para reverter essa tendência, trabalhando na implementação de campanhas de imunização e na educação em saúde (AU).

Introduction: The National Immunization Program present in Primary Health Carecoordinates the immunization process and makes it more effective, but this system faces problems such as lack of internet access and shortages of immunizers, which underminethe population's vaccination coverage and hinderthe electronic recording of indicator data, besides increasing the vaccination abandonment rate.Objective: To analyze the Vaccination Coverage and AbandonmentRate indicators in theNortheasterncapitalsover the last five years.Methodology: Epidemiological, quantitative and descriptive study. The nine capitals of NortheasternBrazil were selected for the study. The themesaddressed arethe VaccinationAbandonment Rate andtheVaccinationCoverage overthe last five years in the capitals. The data was collected through the National Immunization Program Information System and stored in Microsoft Excel.Results:As for vaccination coverage rates, Fortaleza had the highest percentage, with 74.87%. Maceió obtainedthe second highest index, with 66.12%. Regardingvaccinationabandonment rates, Salvador recordedthe highest number,with 27.39% over the last five years. Nonetheless, João Pessoa obtainedthe lowest rate, with 16.08%. Conclusions:It was found that Fortaleza had the highest Vaccination Coverage and Salvador had the highest VaccinationAbandonment Rate.Some capitals had a reduction in Vaccination Coverage and an increase in the VaccinationAbandonment Rate in the pandemic period, indicating the need for more research aboutthe impact of Covid-19 and the circulation of misinformation about vaccination. Therefore, the role of primary health care is essential forreversing this trend, working on the implementation of immunization campaignsand health education (AU).

Introducción:El Programa Nacional de Inmunizaciónpresente en la Atención Primariade Saludcoordina el proceso de inmunización y lo hace más eficaz, pero este sistema se enfrenta a problemas como la falta de acceso a internet y la escasez de inmunizadores, queperjudicanla cobertura de vacunación de la población y dificultan el registro electrónico de los datos de los indicadores, además de aumentar la tasa de abandono de vacunación.Objetivo:Analizar los indicadores de Cobertura de Vacunación y Tasa de Abandono en las capitales del Nordeste en los últimos cinco años.Metodología:Estudio epidemiológico, cuantitativo y descriptivo. Fueron seleccionadas para el estudio las nueve capitales del Nordeste de Brasil. LostemasabordadossonlasTasa de Abandono deVacunacióny la Cobertura de Vacunación en los últimos cinco años en las capitales. Los datos se recogieron a través del Sistema de Información del Programa Nacional de Inmunización y se almacenaron en Microsoft Excel.Resultados:En cuanto a las tasas de cobertura de vacunación, Fortaleza tuvo el porcentaje más elevado, con un74,87%. Maceióobtuvo lasegunda tasa más alta, con un66,12%. En cuanto a las tasas de abandono de vacunación, Salvador registró la cifra más alta, con un27,39% en los últimos cinco años. Sin embargo, João Pessoa obtuvola tasa más baja, con un16,08%.Conclusiones:Se notó queFortaleza tuvo la mayor Cobertura de Vacunación y Salvadortuvola mayor Tasa de Abandono de Vacunación. Algunas capitales tuvieron una reducción de la Cobertura de Vacunacióny un aumento de la Tasa de Abandono de Vacunacióndurante el período pandémico, indicandola necesidad de más investigaciones sobre el impacto de laCovid-19 y la circulación de información errónea sobre la vacunación. Por lo tanto, el rolde la atención primaria de salud es crucial para revertiresta tendencia, trabajando en la implementación de campañas de inmunización y educación sanitaria (AU).

Pain management in the postoperative period of amputation surgeries: A scoping review.

BACKGROUND: Pain in the postoperative period of amputation surgeries, when not managed correctly, can have consequences for the patient. PURPOSES AND OBJECTIVES: The aim of this study was to map the scientific evidence on pain management in patients in the postoperative period of amputation surgeries. DESIGN: Scoping review with elaboration based on the recommendations of the Joanna Briggs Institute, supported by The PAGER framework and guided by the PRISMA-ScR Checklist. METHODS: The survey was conducted in August 2022 in 10 data sources. The 3300 publications found were analysed by two independent reviewers, after applying inclusion and exclusion criteria, 16 studies were selected. RESULTS: Publications occurred between the years 1997 and 2022 and mainly dealt with the management of residual pain and phantom limb through pharmacological measures with pain assessment made by numerical scales. CONCLUSIONS: The literature pointed out strategic uses of analgesics and highlighted technologies for neurostimulation through catheters. The need for new studies with non-pharmacological measures and with designs that can prove their effectiveness is reinforced. RELEVANCE TO CLINICAL PRACTICE: The knowledge of these strategies by health professionals allows adequate pain management and patient follow-up for a less traumatic recovery. PATIENT OR PUBLIC CONTRIBUTION: To patient or public involvement in this scoping review.

Cross-Protection against Acute Staphylococcus aureus Lung Infection in Mice by a D-Glutamate Auxotrophic Vaccine Candidate.

Staphylococcus aureus is regarded as a threatening bacterial pathogen causing invasive pneumonia in healthcare settings and in the community. The continuous emergence of multidrug resistant strains is narrowing the treatment options for these infections. The development of an effective S. aureus vaccine is, therefore, a global priority. We have previously developed a vaccine candidate, 132 ΔmurI Δdat, which is auxotrophic for D-glutamate, and protects against sepsis caused by S. aureus. In the present study, we explored the potential of this vaccine candidate to prevent staphylococcal pneumonia, by using an acute lung infection model in BALB/c mice. Intranasal inoculation of the vaccine strain yielded transitory colonization of the lung tissue, stimulated production of relevant serum IgG and secretory IgA antibodies in the lung and distal vaginal mucosa and conferred cross-protection to acute pneumonia caused by clinically important S. aureus strains. Although these findings are promising, additional research is needed to minimize dose-dependent toxicity for safer intranasal immunization with this vaccine candidate.

Psychosocial aspects of sports medicine in pediatric athletes: Current concepts in the 21st century.

Behavioral aspects of organized sports activity for pediatric athletes are considered in a world consumed with winning at all costs. In the first part of this treatise, we deal with a number of themes faced by our children in their sports play. These concepts include the lure of sports, sports attrition, the mental health of pediatric athletes (i.e., effects of stress, anxiety, depression, suicide in athletes, ADHD and stimulants, coping with injuries, drug use, and eating disorders), violence in sports (i.e., concepts of the abused athlete including sexual abuse), dealing with supervisors (i.e., coaches, parents), peers, the talented athlete, early sports specialization and sports clubs. In the second part of this discussion, we cover ergolytic agents consumed by young athletes in attempts to win at all costs. Sports doping agents covered include anabolic steroids (anabolic-androgenic steroids or AAS), androstenedione, dehydroepiandrostenedione (DHEA), human growth hormone (hGH; also its human recombinant homologue: rhGH), clenbuterol, creatine, gamma hydroxybutyrate (GHB), amphetamines, caffeine and ephedrine. Also considered are blood doping that includes erythropoietin (EPO) and concepts of gene doping. In the last section of this discussion, we look at disabled pediatric athletes that include such concepts as athletes with spinal cord injuries (SCIs), myelomeningocele, cerebral palsy, wheelchair athletes, and amputee athletes; also covered are pediatric athletes with visual impairment, deafness, and those with intellectual disability including Down syndrome. In addition, concepts of autonomic dysreflexia, boosting and atlantoaxial instability are emphasized. We conclude that clinicians and society should protect our precious pediatric athletes who face many challenges in their involvement with organized sports in a world obsessed with winning. There is much we can do to help our young athletes find benefit from sports play while avoiding or blunting negative consequences of organized sport activities.

A prática terapêutica do Tai Chi Chuan em um serviço de referência em práticas integrativas e complementares / The therapeutic practice of Tai Chi Chuan in a reference service for integrative and complementary practices

Resumo O Tai Chi Chuan (TCC) está entre as Práticas Integrativas e Complementares (PICS) mais utilizadas e apresenta, segundo a literatura científica, evidências clínicas para tratamento de diversos problemas de saúde. Entretanto, pouco se sabe sobre o desenvolvimento dessa modalidade no contexto do Sistema Único de Saúde (SUS). Neste sentido, o objetivo do artigo foi compreender a prática terapêutica do TCC em um serviço de referência em PICS no SUS, a partir de um estudo de caso qualitativo com observação participante e entrevistas semiestruturadas com usuários e terapeutas. Observou-se dessemelhanças entre a prática terapêutica do Tai Chi Chuan e as práticas corporais biomédicas, assim como a presença de diretrizes norteadoras de cuidado do SUS, como o acolhimento, a escuta qualificada, o vínculo terapêutico e a integralidade da atenção. Também foi identificada a prevalência de sofrimento mental como motivo de procura pela prática, necessidade de maior apoio financeiro ao serviço e resistência ao uso da Medicina Tradicional Chinesa por parte da rede de apoio de algumas usuárias.

Abstract Tai Chi Chuan (TCC) is among the most used Integrative and Complementary Health Practices (PICS) and, according to the scientific literature, presents clinical evidence for the treatment of various health problems. However, little is known about the development of this practice in the context of the Brazilian National Health System (SUS). In this sense, the objective of the article was to understand the therapeutic practice of TCC in a reference service in PICS in SUS, from a qualitative case study with participant observation and semi-structured interviews with users and therapists. Dissimilarities were observed between the therapeutic practice of TCC and biomedical body practices, as well as the presence of guidelines for SUS care, such as welcoming, qualified listening, therapeutic connection, and comprehensive care. The prevalence of mental distress was also identified as a reason for seeking the practice, as well as the need for greater financial support for the service, and the resistance to the use of Traditional Chinese Medicine by some female users' support network.

New Early Cretaceous species of Zonocypris G. W. Mller, 1898 (Crustacea: Ostracoda) from the Crato Formation, Brazil.

Two new species of Zonocypris G. W. Mller, 1898 are described from the late Aptian of the Araripe Basin, Northeast Brazil: Zonocypris berthoui sp. nov. and Zonocypris dorsoconvexa sp. nov. Species of this genus occur from the Early Cretaceous to the Holocene and are characterized by a small globular carapace, often ornamented over the whole surface by concentric ridges with simple normal pore canals, showing a remarkable morphological stability during the evolution of the genus. The first records of the genus point to an Atlantic origin. In Aptian deposits, species of Zonocypris are rare, occurring in brackish/freshwater assemblages, with marine influence.

In vivo monitoring of Lactiplantibacillus plantarum in the nasal and vaginal mucosa using infrared fluorescence.

Lactic acid bacteria (LAB) of the genus Lactiplantibacillus have been explored as potential mucosal vaccine vectors due to their ability to elicit an immune response against expressed foreign antigens and to their safety. However, tools for monitoring LAB distribution and persistence at the mucosal surfaces are needed. Here, we characterize Lactiplantibacillus plantarum bacteria expressing the infrared fluorescent protein IRFP713 for exploring their in vivo distribution in the mucosa and potential use as a mucosal vaccine vector. This bacterial species is commonly used as a vaginal probiotic and was recently found to have a niche in the human nose. Three different fluorescent L. plantarum strains were obtained using the nisin-inducible pNZRK-IRFP713 plasmid which contains the nisRK genes, showing stable and constitutive expression of IRFP713 in vitro. One of these strains was further monitored in BALB/c mice using near-infrared fluorescence, indicating successful colonization of the nasal and vaginal mucosae for up to 72 h. This study thus provides a tool for the in vivo spatiotemporal monitoring of lactiplantibacilli, allowing non-invasive bacterial detection in these mucosal sites. KEY POINTS: • Stable and constitutive expression of the IRFP713 protein was obtained in different L. plantarum strains. • IRFP713+ L. plantarum 3.12.1 was monitored in vivo using near-infrared fluorescence. • Residence times observed after intranasal and vaginal inoculation were 24-72 h.

A New Live Auxotrophic Vaccine Induces Cross-Protection against Klebsiella pneumoniae Infections in Mice.

The development of a whole-cell vaccine from bacteria auxotrophic for D-amino acids present in the bacterial cell wall is considered a promising strategy for providing protection against bacterial infections. Here, we constructed a prototype vaccine, consisting of a glutamate racemase-deficient mutant, for preventing Klebsiella pneumoniae infections. The deletion mutant lacks the murI gene and requires exogenous addition of D-glutamate for growth. The results showed that the K. pneumoniae ΔmurI strain is attenuated and includes a favourable combination of antigens for inducing a robust immune response and conferring an adequate level of cross-protection against systemic infections caused by K. pneumoniae strains, including some hypervirulent serotypes with elevated production of capsule polysaccharide as well as multiresistant K. pneumoniae strains. The auxotroph also induced specific production of IL-17A and IFN-γ. The rapid elimination of the strain from the blood of mice without causing disease suggests a high level of safety for administration as a vaccine.

Medical perspectives on pediatric sports medicine-Selective topics.

Selective medical perspectives of pediatric sports medicine are explored in this issue and behavioral perspectives of pediatric sports medicine are discussed in a subsequent journal issue. Concepts are considered now dealing with sports readiness involving the child and adolescent that involve understanding the limits imposed by growth and development at different ages as well as pubertal stages. Specializing in one sport too soon is not recommended. Sports readiness also involves understanding and counseling about proper diet and nutrition for maximum sports activity as well as overall health benefits. As clinicians understand sports readiness they can provide a beneficial pre-participation sports examination and deal with qualifications for sports play. Various medical conditions arise in dealing with pediatric persons involved in sports and these are considered in this discussion. They include the female athlete triad, iron deficiency anemia, sports anemia, musculoskeletal overuse injuries, obesity, sudden cardiac death, return to learning after sports-related concussion, epilepsy, asthma, diabetes mellitus, gastrointestinal disorders, genitourinary disorders and dermatology disorders in sports. Clinicians can be very helpful to these young athletes and work with them to ensure the full benefits of sport activities.

Urinary immune cell phenotype of severe AKI in critically ill patients.

PURPOSE: Cellular mechanisms involved in human renal recovery after an episode of acute kidney injury (AKI) are understudied. We aim to characterize the urinary immune cell phenotype of patients with AKI and evaluate its ability to predict renal recovery. METHODS: A prospective study of critically ill patients with stage ≥ 2 AKI by KDIGO and sterile leukocyturia at admission was performed. Urine samples were collected fresh at day 0 and 2 and samples were analyzed by flow cytometry for different leukocytes. Patients were categorized in renal recovery or no-recovery groups. RESULTS: 28 patients were included, all with sepsis, 60.7% of which recovered renal function. The main urinary leukocytes present were neutrophils, followed by mononuclear phagocytic cells and B cells. Patients who recovered renal function had more M2 macrophages at day 2 (p = 0.043) and less B cells at admission (p = 0.006). M2 macrophages had an AUC-ROC of 0.796 (0.601-0.990) for recovery prediction and B cells an AUC-ROC of 0.743 (0.560-0.926) for no recovery. B regulatory cells were found in the urine of AKI patients. CONCLUSIONS: The urinary immune cell phenotype of severe AKI patients was composed essentially of neutrophils, mononuclear phagocytic cells and B cells. Our data suggest that M2 macrophages may promote and B cells preclude renal recovery. More studies are needed to validate our results and further explore the role of immune cells in renal recovery.

Pelvic inflammatory disease in the adolescent and young adult: An update.

Pelvic inflammatory disease (PID) is an infection of the female upper genital tract that is typically polymicrobial with classic core involvement of Neisseria gonorrhoeae and/or Chlamydia trachomatis, though other endogenous flora from the vagino-cervical areas can be involved as well. It is often a sexually transmitted disease but other etiologic routes are also noted. A variety of risk factors have been identified including adolescence, young adulthood, adolescent cervical ectropion, multiple sexual partners, immature immune system, history of previous PID, risky contraceptive practices and others. An early diagnosis and prompt treatment are necessary to reduce risks of PID complications such as chronic pelvic pain, ectopic pregnancy and infertility. Current management principles of PID are also reviewed. It is important for clinicians to screen sexually active females for common sexually transmitted infections such as Chlamydia trachomatis and provide safer sex education to their adolescent and young adult patients. Clinicians should provide comprehensive management to persons with PID and utilize established guidelines such as those from the US Centers for Disease Control and Prevention (CDC).

Blood copper and risk of cardiometabolic diseases: a Mendelian randomization study.

Observational evidence links higher blood levels of copper with higher risk of cardiovascular diseases. However, whether those associations reflect causal links or can be attributed to confounding is still not fully clear. We investigated causal effects of copper on the risk of cardiometabolic endpoints (stroke, coronary artery disease [CAD] and type 2 diabetes) and cardiometabolic risk factors in two-sample Mendelian randomization (MR) studies. The selection of genetic instruments for blood copper levels relied on meta-analysis of genome-wide association studies in three independent studies (European Prospective Investigation into Cancer and Nutrition-Potsdam study, Prospective investigation of the Vasculature in Uppsala Seniors study, Queensland Institute of Medical Research studies). For the selected instruments, outcome associations were drawn from large public genetic consortia on the respective disease endpoints (MEGASTROKE, Cardiogram, DIAGRAM) and cardiometabolic risk factors. MR results indicate an inverse association for genetically higher copper levels with risk of CAD (odds ratio [95% confidence interval] = 0.92 [0.86-0.99], P = 0.022) and systolic blood pressure (beta [standard error (SE)] = -0.238 [0.121]; P = 0.049). Multivariable MR incorporating copper and systolic blood pressure into one model suggested systolic blood pressure as mediating factor between copper and CAD risk. In contrast to previous observational evidence establishing higher blood copper levels as risk-increasing factor for cardiometabolic diseases, this study suggests that higher levels of genetically predicted copper might play a protective role for the development of CAD and systolic blood pressure.