Association between race/color and incidence of hypertension in the ELSA-Brasil population: investigating the mediation of racial discrimination and socioeconomic position.

OBJECTIVE: To investigate the mediation effect of socioeconomic position and racial discrimination in the association between race/color and incidence of hypertension in 4-years follow up. METHODS: We included 8,370 participants of the Longitudinal Study of Adult Health (ELSA-Brasil). A latent variable was constructed to represent socioeconomic position (SEP). The perception of discrimination was measured through an adaptation of the Lifetime Major Events Scale; and hypertension was defined using standard criteria. We investigated Body Mass Index (BMI) due to its role in proximal risk for hypertension. To investigate the mediating role of SEP and racial discrimination, we used structural equation modeling. RESULTS: SEP had a direct and negative effect on HT incidence (HT incidence increased in worse SEP categories), while the effect of BMI on HT was direct and positive. We did not find significant direct effects of race/color and racial discrimination on HT. As for indirect effects, we observed associations between race/color and HT only through SEP mediation. CONCLUSION: According to our results, race/color is indirectly related to HT incidence, mediated by SEP. Racial discrimination was not a mediator in the relationship between race/color and HT in the follow-up period.

What are microbiological effects of the adjunctive use of probiotics in the treatment of periodontal diseases? A systematic review.

Probiotics have aroused great interest as an adjunctive treatment to periodontal therapy, due to the frequent colonisation by periodontopathogens after therapy. The aim of this systematic review was to analyse in the scientific literature, evidence of the microbiological effects of probiotics as an adjunct to periodontal therapy in the treatment of periodontal diseases (PD). Only randomised controlled trials (RCT), evaluating the microbiological effect of probiotics as an adjunct to periodontal therapy. The authors conducted a search in PubMed/MEDLINE, LILACS, ScienceDirect, Web of Science and Cochrane Library to identify articles published in English until February 2020. The quality of the studies was assessed using the JADAD scale and the risk of bias was assessed according to the Cochrane Collaboration assessment tool. Of the 265 articles potentially relevant to this review, 10 studies were included. The most frequently used probiotic bacteria were those of the genus Lactobacillus spp. and the time of administration of the probiotics was between 14 days to 3 months. Most studies have shown that the adjuvant use of probiotics reduces the total mean counts of gram-negative anaerobic species (Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola and Prevotella intermedia) and gram-negative coccobacillus (Aggregatibacter actinomycetemcomitans) of subgingival plaque samples. Probiotics adjuvant to periodontal therapy reduces periodontopathogenic species in a greater proportion, compared only to periodontal therapy. Especially the Lactobacillus reuteri strain, without combination with other strains, offered a greater reduction in pathogenic bacteria associated with greater destruction of periodontal tissues and deep periodontal pockets. Researchers should perform high-quality RCT, evaluating single strains without combinations, in order to observe the microbiological benefits as adjunctive treatment of PD.

F/OH ratio in a rare fluorine-poor blue topaz from Padre Paraíso (Minas Gerais, Brazil) to unravel topaz's ambient of formation.

Topaz [Al2SiO4(F,OH)2] is one of the main fluorine-bearing silicates occurring in environments where variably acidic (F)/aqueous (OH) fluids saturate the silicate system. In this work we fully characterized blue topaz from Padre Paraíso (Minas Gerais, Brazil) by means of in situ synchrotron X-Ray and neutron powder diffraction measurements (temperature range 298-1273 K) combined with EDS microanalyses. Understanding the role of OH/F substitution in topaz is important in order to determine the hydrophilicity and the exchange reactions of fluorine by hydroxyl groups, and ultimately to characterize the environmental redox conditions (H2O/F) required for mineral formation. The fluorine content estimated from neutron diffraction data is ~ 1.03 a.f.u (10.34 wt%), in agreement with the chemical data (on average 10.0 wt%). The XOH [OH/(OH + F)] (0.484) is close to the maximum XOH value (0.5), and represents the OH- richest topaz composition so far analysed in the Minas Gerais district. Topaz crystallinity and fluorine content sharply decrease at 1170 K, while mullite phase starts growing. On the basis of this behaviour, we suggest that this temperature may represent the potential initial topaz's crystallization temperature from supercritical fluids in a pegmatite system. The log(fH2O/fHF)fluid (1.27 (0.06)) is coherent with the fluorine activity calculated for hydrothermal fluids (pegmatitic stage) in equilibrium with the forming mineral (log(fH2O/fHF)fluid = 1.2-6.5) and clearly different from pure magmatic (granitic) residual melts [log(fH2O/fHF)fluid < 1]. The modelled H2O saturated fluids with the F content not exceeding 1 wt% may represent an anomalous water-dominant / fluorine-poor pegmatite lens of the Padre Paraíso Pegmatite Field.

No man is an island: spatial clustering and access to primary care as possible targets for the development of new community mental health approaches.

BACKGROUND: to understand if patients seen at Centro Hospitalar Psiquiátrico de Lisboa (CHPL) live in geographical clusters or randomly throughout the city, as well as determine their access to the psychiatric hospital and primary care facilities (PCF). METHODS: spatial autocorrelation statistics were performed (queen criterion of contiguity), regarding all patients observed at CHPL in 2017 (at the census subsection level), and considering not only their overall number but also main diagnosis, and admission to the psychiatric ward - voluntary or compulsory. Distance to the hospital and to the closest PCF was measured (for each patient and the variables cited above), and the mean values were compared. Finally, the total number of patients around each PCF was counted, considering specified radius sizes of 656 and 1000 m. RESULTS: All 5161 patients (509 psychiatric admissions) were geolocated, and statistical significance regarding patient clustering was found for the total number (p-0.0001) and specific group of disorders, namely Schizophrenia and related disorders (p-0.007) and depressive disorders (p-0.0002). Patients who were admitted in a psychiatric ward live farther away from the hospital (p-0.002), with the compulsory admissions (versus voluntary ones) living even farther (p-0.004). Furthermore, defining a radius of 1000 m for each PCF allowed the identification of two PCF with more than 1000 patients, and two others with more than 800. CONCLUSIONS: as patients seem to live in geographical clusters (and considering PCFs with the highest number of them), possible locations for the development of programs regarding mental health treatment and prevention can now be identified.

Whole-brain white matter organization, intelligence, and educational attainment.

General cognitive ability, sometimes referred to as intelligence, is associated with educational attainment throughout childhood. Most studies that have explored the neural correlates of intelligence in childhood focus on individual brain regions. This analytical approach is designed to identify restricted sets of voxels that overlap across participants. By contrast, we explored the relationship between white matter connectome organization, intelligence, and education. In both a sample of typically-developing children (N = 63) and a sample of struggling learners (N = 139), the white matter connectome efficiency was strongly associated with intelligence and educational attainment. Further, intelligence partially mediated the relationship between connectome efficiency and educational attainment. In contrast, a canonical voxel-wise analysis failed to identify any significant relationships. The results emphasize the importance of distributed brain network properties for cognitive or educational ability in childhood. Our findings are interpreted in the context of a developmental theory, which emphasizes the interaction between different subsystems over developmental time.

Preventing intrusive memories after trauma via a brief intervention involving Tetris computer game play in the emergency department: a proof-of-concept randomized controlled trial.

After psychological trauma, recurrent intrusive visual memories may be distressing and disruptive. Preventive interventions post trauma are lacking. Here we test a behavioural intervention after real-life trauma derived from cognitive neuroscience. We hypothesized that intrusive memories would be significantly reduced in number by an intervention involving a computer game with high visuospatial demands (Tetris), via disrupting consolidation of sensory elements of trauma memory. The Tetris-based intervention (trauma memory reminder cue plus c. 20 min game play) vs attention-placebo control (written activity log for same duration) were both delivered in an emergency department within 6 h of a motor vehicle accident. The randomized controlled trial compared the impact on the number of intrusive trauma memories in the subsequent week (primary outcome). Results vindicated the efficacy of the Tetris-based intervention compared with the control condition: there were fewer intrusive memories overall, and time-series analyses showed that intrusion incidence declined more quickly. There were convergent findings on a measure of clinical post-trauma intrusion symptoms at 1 week, but not on other symptom clusters or at 1 month. Results of this proof-of-concept study suggest that a larger trial, powered to detect differences at 1 month, is warranted. Participants found the intervention easy, helpful and minimally distressing. By translating emerging neuroscientific insights and experimental research into the real world, we offer a promising new low-intensity psychiatric intervention that could prevent debilitating intrusive memories following trauma.

Simultaneous Kidney-Pancreas Transplantation With an Original "Transverse Pancreas" Technique: Initial 9 Years' Experience With 56 Cases.

An innovative technique for pancreas transplantation is described. The main aspect consists of the horizontal positioning of the pancreas, which allows a better venous outflow, thus preventing thrombosis and graft loss. The program of pancreas transplantation in this national reference center for pancreatic and liver surgery was started in 2007; the initial results were considered poor, resulting in the loss of half of the grafts due to venous thrombosis. After analyzing the possible causes, this technique was proposed and successfully implemented, reducing the postoperative complications, particularly the problem of venous thrombosis. A detailed description of the new surgical technique is provided. The main clinical and demographic characteristics of the 56 patients who underwent the surgery are analyzed. The incidence of venous thrombosis was 5.3% (3 patients) and graft loss was 3.5% (2 patients). Due to the good results, this technique became the standard surgery for transplantation of the pancreas in our center. The technique proved to be safe and successful. Due to the unique pancreas graft implantation, we called it "transverse pancreas surgery."

Differences between endogenous attention to spatial locations and sensory modalities.

Vibell et al. (J Cogn Neurosci 19:109-120, 2007) reported that endogenously attending to a sensory modality (vision or touch) modulated perceptual processing, in part, by the relative speeding-up of neural activation (i.e., as a result of prior entry). However, it was unclear whether it was the fine temporal discrimination required by the temporal-order judgment task that was used, or rather, the type of attentional modulation (spatial locations or sensory modalities) that was responsible for the shift in latencies that they observed. The present study used a similar experimental design to evaluate whether spatial attention would also yield similar latency effects suggestive of prior entry in the early visual P1 potentials. Intriguingly, while the results demonstrate similar neural latency shifts attributable to spatial attention, they started at a somewhat later stage than seen in Vibell et al.'s study. These differences are consistent with different neural mechanisms underlying attention to a specific sensory modality versus to a spatial location.

Preparatory α-band oscillations reflect spatial gating independently of predictions regarding target identity.

Preparatory modulations of cortical α-band oscillations are a reliable index of the voluntary allocation of covert spatial attention. It is currently unclear whether attentional cues containing information about a target's identity (such as its visual orientation), in addition to its location, might additionally shape preparatory α modulations. Here, we explore this question by directly comparing spatial and feature-based attention in the same visual detection task while recording brain activity using magnetoencephalography (MEG). At the behavioral level, preparatory feature-based and spatial attention cues both improved performance and did so independently of each other. Using MEG, we replicated robust α lateralization following spatial cues: in preparation for a visual target, α power decreased contralaterally and increased ipsilaterally to the attended location. Critically, however, preparatory α lateralization was not significantly modulated by predictions regarding target identity, as carried via the behaviorally effective feature-based attention cues. Furthermore, nonlateralized α power during the cue-target interval did not differentiate between uninformative cues and cues carrying feature-based predictions either. Based on these results we propose that preparatory α modulations play a role in the gating of information between spatially segregated cortical regions and are therefore particularly well suited for spatial gating of information.NEW & NOTEWORTHY The present work clarifies if and how human brain oscillations in the α-band support multiple types of anticipatory attention. Using magnetoencephalography, we show that posterior α-band oscillations are modulated by predictions regarding the spatial location of an upcoming visual target, but not by feature-based predictions regarding its identity, despite robust behavioral benefits. This provides novel insights into the functional role of preparatory α mechanisms and suggests a limited specificity with which they may operate.

Operational decision support system for large combined sewage systems: Lisbon/Tagus estuary case study.

Managing combined sewage systems in large cities discharging to coastal waters, often bearing recreational activities, remains a challenge. Studying the impacts of such discharges requires the development of specific models. Hydrodynamic and water quality modelling of coastal waters employs numerical methods and algorithms, leading to the design of complex models which require expert use. The use of such models as decision support tools to simulate discharge impacts and define adequate corrective measures could represent a key part in meeting this challenge. In this paper, the authors describe the work undertaken to develop an operational decision support system (ODSS) methodology aiming to enable wastewater utilities' non-expert staff to carry out user-friendly scenario analysis based on computational fluid dynamics simulations. This article depicts the application and validation of the ODSS to the combined sewage system and the Tagus estuary of the city of Lisbon in Portugal. The ODSS was used for simulating the effects in the receiving coastal waters of a discharge caused by a scheduled maintenance operation in the sewage infrastructure. Results show that the use of such ODSS by non-expert staff increases their decision capabilities and knowledge of the wastewater utility's contribution to reducing negative impacts of sewage discharges on the receiving water bodies.

Evaluation of the effectiveness of mass trapping with BG-sentinel traps for dengue vector control: a cluster randomized controlled trial in Manaus, Brazil.

The objective of this study was to assess the effectiveness of BG-Sentinel (BGS) traps for mass trapping at the household level to control the dengue vector, Aedes aegypti (L.), in Manaus (Brazil) by performing a cluster randomized controlled trial. After an initial questionnaire and baseline monitoring, 6 out of 12 clusters were randomly allocated to the intervention arm, where participating premises received one BGS trap for mass trapping. The other six clusters did not receive traps and were considered as the control arm. Biweekly monitoring with BGS in both arms assessed the impact of mass trapping. At the end of the study, a serological survey was conducted and a second questionnaire was conducted in the intervention arm. Entomological monitoring indicated that mass trapping with BGS traps significantly reduced the abundance of adult female Ae. aegypti during the first five rainy months. In the subsequent dry season when the mosquito population was lower, no effect of mass trapping was observed. Fewer Ae. aegypti females were measured in the intervention arm during the next rainy period, but no significant difference between arms was observed. The serological survey revealed that in participating houses of mass trapping areas recent dengue infections were less common than in control areas, although this effect was not statistically significant. The majority of participants responded positively to questions concerning user satisfaction. Our results suggest that BGS traps are a promising tool which might be deployed as part of dengue control programs; however, further investigations and larger scale studies are necessary.

Inferring task-related networks using independent component analysis in magnetoencephalography.

A novel framework for analysing task-positive data in magnetoencephalography (MEG) is presented that can identify task-related networks. Techniques that combine beamforming, the Hilbert transform and temporal independent component analysis (ICA) have recently been applied to resting-state MEG data and have been shown to extract resting-state networks similar to those found in fMRI. Here we extend this approach in two ways. First, we systematically investigate optimisation of time-frequency windows for connectivity measurement. This is achieved by estimating the distribution of functional connectivity scores between nodes of known resting-state networks and contrasting it with a distribution of artefactual scores that are entirely due to spatial leakage caused by the inverse problem. We find that functional connectivity, both in the resting-state and during a cognitive task, is best estimated via correlations in the oscillatory envelope in the 8-20 Hz frequency range, temporally down-sampled with windows of 1-4s. Second, we combine ICA with the general linear model (GLM) to incorporate knowledge of task structure into our connectivity analysis. The combination of ICA with the GLM helps overcome problems of these techniques when used independently: namely, the interpretation and separation of interesting independent components from those that represent noise in ICA and the correction for multiple comparisons when applying the GLM. We demonstrate the approach on a 2-back working memory task and show that this novel analysis framework is able to elucidate the functional networks involved in the task beyond that which is achieved using the GLM alone. We find evidence of localised task-related activity in the area of the hippocampus, which is difficult to detect reliably using standard methods. Task-positive ICA, coupled with the GLM, has the potential to be a powerful tool in the analysis of MEG data.

Biomethanation potential of macroalgae Ulva spp. and Gracilaria spp. and in co-digestion with waste activated sludge.

Biochemical methane potential of four species of Ulva and Gracilaria genus was assessed in batch assays at mesophilic temperature. The results indicate a higher specific methane production (per volatile solids) for one of the Ulva sp. compared with other macroalgae and for tests running with 2.5% of total solids (196±9 L CH(4) kg(-1)VS). Considering that macroalgae can potentially be a post treatment of municipal wastewater for nutrients removal, co-digestion of macroalgae with waste activated sludge (WAS) was assessed. The co-digestion of macroalgae (15%) with WAS (85%) is feasible at a rate of methane production 26% higher than WAS alone without decreasing the overall biodegradability of the substrate (42-45% methane yield). The use of anoxic marine sediment as inoculum had no positive effect on the methane production in batch assays. The limiting step of the overall anaerobic digestion process was the hydrolysis.

Analysis of postural oscillation in children with cerebral palsy.

It is believed that static balance undergoes changes in children with cerebral palsy (CP). Thus, we analyzed postural oscillation in 19 children with the aim of comparing balance between healthy children and those with CP. The sample was divided into two groups--one with 10 children diagnosed with diparetic CP (CPG) and a control group (CG) with nine healthy children, all capable of remaining in an orthostatic position without support and obeying spoken commands. The assessment of postural oscillation was performed with the children barefoot, arms alongside the body and looking toward a fixed point while standing on an unrestricted base for the feet. Data collection was performed using a TEKScan force platform with 30-second duration for each condition. The children had an average age of 7.9 years (+/- 2.07) in the CPG and 7.5 years (+/- 1.58) for the CG. Postural oscillation data in the anterior-posterior and medial-lateral directions were analyzed using the Data Analysis and Technical Graphics Origin 6.0 program. Statistical analysis of the mean oscillation value in the conditions of eyes open and eyes closed did not differ significantly between groups. However, there was a significant difference in mean anterior-posterior oscillation between groups (p = 0.00). The groups behaved similarly with regard to the visual deprivation. We conclude that children with CP exhibit less postural oscillation in comparison to healthy children under the same conditions.

[Myocardial abscess of the right ventricle anterior wall]. / Abcesso miocárdico da parede anterior do ventrículo direito.

The authors report the clinical case of a 63 old male, with a previous history of aortic mechanical replacement valve, who was admitted with fever, neutrophilic leukocytosis and c-reactive protein elevation. During admission Escherichia coli was cultured from blood, and the patient underwent repeated transthoracic and transesophageal echocardiograms, that did not reveal any abnormalities. Three weeks after admission, a new transesophageal echocardiogram showed an image suggestive of an aortic annular abscess. The patient was transferred to the Cardiothoracic Department of Santa Maria Hospital, in order to be submitted to surgical treatment. During the procedure an abscess in the anterior wall of right ventricle was diagnosed. The microbiological cultures of pus were negative. It was assumed the diagnosis of E. coli myocardial abscess. The diagnostic approach to patients with febrile syndrome and mechanical replacement valve should consider the hypothesis of infectious endocarditis and myocardial abscess, despite the rarity of its occurrence.

[Cardiological medical treatment after coronary bypass surgery]. / Terapêutica cardiológica no pós-operatório de cirurgia coronária.

When a decision has been reached to proceed with coronary bypass surgery, this represents a therapeutical option for a partnership between surgical revascularization and an optimized multifaceted medical treatment. We report the guidelines implemented in our department concerning the secondary prevention therapy after coronary bypass surgery. The antiplatelet therapy (and its association with coumadin), the bradycardizing treatments (with a special reference to the approach of unappropriate sinus tachycardia), the specific anti-ischemic therapy, the treatment of dyslipidemia, and the antihypertensive therapy are reviewed as well as the use of additional anti-atheromatous measures, the approach of hyperuricemia and hyperhomocysteinemia, and the oral antidiabetic treatment.

Expression, purification and osteogenic bioactivity of recombinant human BMP-4, -9, -10, -11 and -14.

Bone morphogenetic proteins (BMPs) are cytokines from the TGF-beta superfamily, with important roles during embryonic development and in the induction of bone and cartilage tissue differentiation in the adult body. In this contribution, we report the expression of recombinant human BMP-4, BMP-9, BMP-10, BMP-11 (or growth differentiation factor-11, GDF-11) and BMP-14 (GDF-5), using Escherichia coli pET-25b vector. BMPs were overexpressed, purified by affinity his-tag chromatography and shown to induce the expression of early markers of bone differentiation (e.g. smad-1, smad-5, runx2/cbfa1, dlx5, osterix, osteopontin, bone sialoprotein and alkaline phosphatase) in C2C12 cells and in human adipose stem cells. The described approach is a promising method for producing large amounts of different recombinant BMPs that show potential for novel biomedical applications.

[The impact of the "patient - prosthesis mismatch" in patients with aortic valve replacement.]. / Impacto do "patient-prosthesis mismatch" em doentes submetidos a substituição valvular aórtica.

UNLABELLED: Patient-Prosthesis Mismatch (PPM) is still a controversial matter in our days. We have PPM when the orifice area of an implanted aortic prosthesis valve is too small for the body surface area of an individual; this is, when the orifice area indexed to the body surface area is <0.8-0.9 cm2/m2. OBJECTIVE: Assess the impact of Patient-Prosthesis Mismatch in the short term and 2 years follow up in a group of patients submitted to aortic valve replacement. MATERIAL AND METHODS: The authors present a retrospective study involving 343 patients with a mean age of 64,68+/-12,4 years that were submitted to aortic valve replacement between January 2005 and December 2008. Data were collected from patients' files and direct contact with the patients, comparing the groups with and without PPM and correlating them in terms of Euroscore, demographics, type of implanted prosthesis, surgical times, ICU and hospital stay. The data related to short term and long term mortality as well as the NYHA class evolution were also obtained. RESULTS: Using the cut-off related to effective orifice area index 0,9 cm2/m2 we found PPM in 109 patients (31.7%). When comparing the two groups, we found that PPM seems to be related to advanced age (p=0.001), biological prosthesis (p=0.01) and, as expected, with use of valves less than 21 (p<0,05). A statistical significant difference was found for: 1) short-term mortality in patients with PPM (p<0,001), however, there were no differences in 2 years mortality and NYHA class between the groups; 2) aorta's cross clamping and extra corporeal circulation time (p=0.047 and p=0.036, respectively).

[Kommerell diverticula associated with dysphagia: a clinical case and review of the literature]. / Disfagia associada a divertículo de Kommerell. Caso clínico e revisão bibliográfica.

We report the case of a young female with disphagia and weigth loss caused by a vascular ring associated with right aortic arch, Kommerell diverticula, and left retroesophageal ligamentum arteriosum (ductus arteriosus). The patient underwent surgical treatment. A left thoracotomy was performed. Surgical technique included diverticulum ressection and an aortopexia. There were no major complications. We also discuss the incidence, pathology, diagnosis, clinical features and treatment of this rare disease.