Toxicity Mechanisms of Gadolinium and Gadolinium-Based Contrast Agents-A Review.

Gadolinium-based contrast agents (GBCAs) have been used for more than 30 years to improve magnetic resonance imaging, a crucial tool for medical diagnosis and treatment monitoring across multiple clinical settings. Studies have shown that exposure to GBCAs is associated with gadolinium release and tissue deposition that may cause short- and long-term toxicity in several organs, including the kidney, the main excretion organ of most GBCAs. Considering the increasing prevalence of chronic kidney disease worldwide and that most of the complications following GBCA exposure are associated with renal dysfunction, the mechanisms underlying GBCA toxicity, especially renal toxicity, are particularly important. A better understanding of the gadolinium mechanisms of toxicity may contribute to clarify the safety and/or potential risks associated with the use of GBCAs. In this work, a review of the recent literature concerning gadolinium and GBCA mechanisms of toxicity was performed.

Age-Related Changes in Clinical and Analytical Variables in Chronic Hemodialyzed Patients.

Worldwide, the number of elderly individuals receiving chronic hemodialysis is rising. The aim of our study was to evaluate several clinical and analytical biomarkers in chronically dialyzed patients and analyze how they change with age. A cross-sectional study was performed by evaluating 289 end-stage renal disease patients undergoing dialysis. We evaluated the hemogram, adipokines, the lipid profile, and several markers related to inflammation, endothelial function/fibrinolysis, nutrition, iron metabolism, and cardiac and renal fibrosis. Clinical data and dialysis efficacy parameters were obtained from all patients. The relationships between studied biomarkers and age were assessed by a statistical comparison between younger (adults with age < 65 years) and older (age ≥ 65 years) patients and by performing regression analysis. Participants presented a mean age of 68.7 years (±13.6), with 66.8% (n = 193) being classified as older. Compared to younger patients, older patients presented the following: (a) significantly lower values of diastolic blood pressure (DBP) and ultrafiltration volume; (b) lower levels of phosphorus, uric acid, creatinine, and albumin; and (c) higher circulating concentrations of tissue-type plasminogen activator (tPA), D-dimer, interleukin-6, leptin, N-terminal pro B-type natriuretic peptide, and tissue inhibitor of metalloproteinase-1. In the multiple linear regression analysis, DBP values, tPA, phosphorus, and D-dimer levels were independently associated with the age of patients (standardized betas: -0.407, 0.272, -0.230, and 0.197, respectively; p < 0.001 for all), demonstrating relevant changes in biomarkers with increasing age at cardiovascular and nutritional levels. These findings seem to result from crosstalk mechanisms between aging and chronic kidney disease.

Reticulocyte Antioxidant Enzymes mRNA Levels versus Reticulocyte Maturity Indices in Hereditary Spherocytosis, ß-Thalassemia and Sickle Cell Disease.

The antioxidant enzymes superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx) and peroxiredoxin 2 (Prx2) are particularly important in erythroid cells. Reticulocytes and other erythroid precursors may adapt their biosynthetic mechanisms to cell defects or to changes in the bone marrow environment. Our aim was to perform a comparative study of the mRNA levels of CAT, GPX1, PRDX2 and SOD1 in reticulocytes from healthy individuals and from patients with hereditary spherocytosis (HS), sickle cell disease (SCD) and ß-thalassemia (ß-thal), and to study the association between their transcript levels and the reticulocyte maturity indices. In controls, the enzyme mRNA levels were significantly correlated with reticulocyte maturity indices for all genes except for SOD1. HS, SCD and ß-thal patients showed younger reticulocytes, with higher transcript levels of all enzymes, although with different patterns. ß-thal and HS showed similar reticulocyte maturity, with different enzyme mRNA levels; SCD and HS, with different reticulocyte maturity, presented similar enzyme mRNA levels. Our data suggest that the transcript profile for these antioxidant enzymes is not entirely related to reticulocyte maturity; it appears to also reflect adaptive mechanisms to abnormal erythropoiesis and/or to altered erythropoietic environments, leading to reticulocytes with distinct antioxidant potential according to each anemia.

Contribuitions for teaching religiosity/spirituality in undergraduate nursing programs: a qualitative study with Brazilian nurses / Contribuições para o ensino de religiosidade/espiritualidade na graduação em enfermagem: estudo qualitativo com enfermeiros brasileiros / Contribuciones para enseñanza de religiosidad/espiritualidad en la graduación en enfermería: estudio cualitativo con enfermeros brasileños

Objective:to identify and collect recommendations for teaching religiosity/spirituality in undergraduate Nursing courses of nurses working in a Hospital. Method:this is a qualitative study, with 34 nurses interviewed. The research corpus was fully transcribed and submitted to content analysis. Results:the religiosity/spirituality theme was absent in the graduation of most of professionals. They mentioned the restricted preparation to deal with human issues and for being a dimension that offers a resource to face thechallenges of the daily life of the profession. What mitigated this gap was that some professionals have their own religious/spiritual beliefs, which have often guided how this religious/spiritual support is provided in health care.Conclusions:participants suggest the presence of religiosity/spirituality teaching in nursing graduation effectively and practically, not only theoretically reinforce its importance. Taking religiosity/spirituality content to undergraduate courses can be sensitive to the holistic needs of patients/users and even the professionals themselves.

Objetivo: identificar e coletar recomendações para o ensino da religiosidade/espiritualidade na graduação em Enfermagem a partir de enfermeiros de um Hospital. Método: estudo qualitativo, com 34 enfermeiros(as) entrevistados(as). O corpus de pesquisa foi transcrito na íntegra e submetido à análise conteúdo. Resultados:areligiosidade/espiritualidade esteve ausente na graduação da maioria dos profissionais e é referida em termos da restrita preparação para lidar com questões humanas e por ser uma dimensão que oferece enfrentamento para os desafios do cotidiano da profissão. O que atenuou essa lacuna foi a presença da própria crença religiosa/espiritual, o que tem balizado, muitas vezes, como o apoio religioso/espiritual é oferecido no cuidado. Conclusões:os participantes sugerem o ensino da religiosidade/espiritualidade na graduação em enfermagem de maneira efetiva e prática, não apenas reforçar sua importância. Levar esse conteúdo para a graduação pode se mostrar sensível às necessidades holísticas dos pacientes/usuários e até mesmo dos próprios profissionais.

Objetivo:identificar y recoger recomendaciones para la enseñanza de la religiosidad/espiritualidad en la graduación de enfermería de enfermeros de un hospital. Método: estudio cualitativo, con 34 enfermeros entrevistados. El corpus de investigación fue transcrito en su totalidad y sometido a análisis de contenido. Resultados:la religiosidad/espiritualidad estuvo ausente en la formación de la mayoría de estos profesionales y es señalada por su falta de preparación para enfrentar los problemas humanos y porque es una dimensión que ofrece recursos para enfrentar del día a día. Las creencias religiosas/espirituales de los profesionales paliaron esta brecha, que muchas veces ha marcado cómo se ofrece el apoyo religioso/espiritual en el cuidado. Conclusiones:la religiosidad/espiritualidad en la graduación de enfermería se sugiere de manera práctica, no solo reforzando su importancia. Contenidos de religiosidad/espiritualidad a los cursos de pregrado puede ser sensible a las necesidades holísticas de los pacientes/usuarios e incluso de los propios profesionales.

The Association of Leptin with Left Ventricular Hypertrophy in End-Stage Kidney Disease Patients on Dialysis.

Left ventricular hypertrophy (LVH) is a common cardiovascular complication in end-stage kidney disease (ESKD) patients. We aimed at studying the association of LVH with adiponectin and leptin levels, cardiovascular stress/injury biomarkers and nutritional status in these patients. We evaluated the LV mass (LVM) and calculated the LVM index (LVMI) in 196 ESKD patients on dialysis; the levels of hemoglobin, calcium, phosphorus, parathyroid hormone, albumin, adiponectin, leptin, N-terminal pro B-type natriuretic peptide (NT-proBNP) and growth differentiation factor (GDF)-15 were analyzed. ESKD patients with LVH (n = 131) presented higher NT-proBNP and GDF-15, lower hemoglobin and, after adjustment for gender, lower leptin levels compared with non-LVH patients. LVH females also showed lower leptin than the non-LVH female group. In the LVH group, LVMI presented a negative correlation with leptin and a positive correlation with NT-proBNP. Leptin emerged as an independent determinant of LVMI in both groups, and NT-proBNP in the LVH group. Low hemoglobin and leptin and increased calcium, NT-proBNP and dialysis vintage are associated with an increased risk of developing LVH. In ESKD patients on dialysis, LVH is associated with lower leptin values (especially in women), which are negatively correlated with LVMI, and with higher levels of biomarkers of myocardial stress/injury. Leptin and NT-proBNP appear as independent determinants of LVMI; dialysis vintage, hemoglobin, calcium, NT-proBNP and leptin emerged as predicting markers for LVH development. Further studies are needed to better understand the role of leptin in LVH in ESKD patients.

Inhibition of erythrocyte's catalase, glutathione peroxidase or peroxiredoxin 2 - Impact on cytosol and membrane.

Catalase (CAT), glutathione peroxidase (GPx) and Prx2 (peroxiredoxin 2) are the main antioxidant enzymatic defenses of erythrocytes. They prevent and minimize oxidative injuries in red blood cell (RBC) components, which are continuously exposed to oxidative stress (OS). The crosstalk between CAT, GPx and Prx2 is still not fully disclosed, as well as why these typically cytoplasmic enzymes bind to the RBC membrane. Our aim was to understand the interplay between CAT, GPx and Prx2 in the erythrocyte's cytosol and membrane. Under specific (partial) inhibition of each enzyme and increasing H2O2-induced OS conditions, we evaluated the enzyme activities and amounts, the binding of CAT, GPx and Prx2 to RBC membrane, and biomarkers of OS, such as the reduced and oxidized glutathione levels, thiobarbituric acid reactive substances (TBARS) levels, membrane bound hemoglobin and total antioxidant status. Our results support the hypothesis that when high levels of H2O2 get within the erythrocyte, CAT is the main player in the antioxidant protection of the cell, while Prx2 and GPx have a less striking role. Moreover, we found that CAT, appears to have more importance in the antioxidant protection of cytoplasm than of the membrane components, since when the activity of CAT is disturbed, GPx and Prx2 are both activated in the cytosol and mobilized to the membrane. In more severe OS conditions, the antioxidant activity of GPx is more significant at the membrane, as we found that GPx moves from the cytosol to the membrane, probably to protect it from lipid peroxidation.

Psychological Adjustment Profiles of LGBTQ+ Young Adults Residing with Their Parents during the COVID-19 Pandemic: An International Study.

The COVID-19 pandemic has been associated with poor mental health symptoms, particularly among vulnerable populations such as LGBTQ+ individuals. In the present study, we aimed to (i) identify different psychological adjustment profiles among LGBTQ+ young adults during the COVID-19 pandemic and compare LGBTQ+ young adults in relation to (ii) sociodemographic characteristics and COVID-19-related experiences and (iii) the internal and external protective resources associated with each adjustment profile. An online questionnaire was administered to 1699 LGBTQ+ young adults from six countries (Brazil, Chile, Italy, Portugal, Sweden, and the UK). A cluster analysis was conducted, and four profiles of psychological adjustment were identified: unchallenged, resilient, distressed, and at-risk. The at-risk cluster scored lowest in social support (particularly from family). The profiles of participants who experienced the highest levels of pandemic adversity (at-risk and resilient) comprised mostly South American participants, those under lockdown at the time of survey completion, those who self-identified as transgender and non-binary, and those with a plurisexual sexual orientation. Interventions should consider strategies to help young adults maintain support systems and reinforce the value of positive family relationships. Specific groups within the LGBTQ+ community that seem to be in a particularly vulnerable situation may need additional tailored support.

New Insights into Adiponectin and Leptin Roles in Chronic Kidney Disease.

Chronic kidney disease (CKD) is commonly associated with a high burden of comorbidities and poor clinical outcomes. Malnutrition-inflammation-atherosclerosis syndrome is common in the more severe stages of CKD, suggesting a close interplay for these three comorbid conditions. Both malnutrition and obesity are associated with a disturbed adipokine profile and inflammation, contributing to a higher risk of cardiovascular disease (CVD) events. Adiponectin and leptin have important roles in carbohydrate and lipid metabolism, and in the inflammatory process. The effects of adiponectin and leptin alterations in CKD, which are usually increased, and their association with the different comorbidities found in CKD, will be focused on to understand their crosstalk with the risk of CVD events. Nonetheless, although adiponectin and leptin contribute to a higher risk of CVD events, further studies are warranted to fully clarify their roles, especially when different comorbidities exist.

Escala de Discriminação Cotidiana para Adolescentes e Jovens: Adaptação e Evidências Psicométricas / Everyday Discrimination Scale for Adolescents and Youth: Adaptation and Psychometric Evidence / Escala de Discriminación en la Vida Cotidiana para Adolescentes y Jóvenes: Adaptación y Pruebas Psicométricas

A discriminação tem um impacto negativo na saúde mental e nos desfechos acadêmicos e socioemocionais das pessoas. Um dos instrumentos mais usados para medir a frequência de experiências de discriminação é a Escala de Discriminação Cotidiana. Contudo, esta escala não foi ainda adaptada ao contexto brasileiro. Desta forma, o objetivo deste estudo foi adaptar e validar a Escala de Discriminação Cotidiana em uma amostra de adolescentes e jovens brasileiros de nível socioeconômico baixo e descrever os motivos de discriminação mais prevalentes. Analisou-se as equivalências linguísticas e a estrutura factorial da escala. A amostra foi composta de 995 estudantes pobres, advindos do Ensino Fundamental de cinco escolas públicas do Estado do Rio de Janeiro e de duas universidades públicas do Estado do Ceará, com idade entre 11 e 29 anos (M = 15,81, DP = 3,55), 54,8% constituída por mulheres (n = 522). A Análise Fatorial Exploratória realizada revelou uma estrutura unifatorial, com boa confiabilidade e validade. Os motivos de discriminação mais frequentes foram a aparência física e o nível socioeconômico. Os achados sugerem que a versão adaptada da escala apresenta qualidades psicométricas que permitem a sua utilização junto a adolescentes e jovens brasileiros.

Discrimination has a negative impact on people's mental health and academic and socio-emotional outcomes. One of the most commonly used instruments to assess the frequency of discrimination experiences is the Everyday Discrimination Scale. However, this instrument has not yet been adapted to the Brazilian context. Hence, this study aimed to adapt and validate the Everyday Discrimination Scale to a sample of Brazilian adolescents and young adults of low socioeconomic level and describe the most prevalent grounds for discrimination. Linguistic equivalences and the scale's factorial structure were analyzed. The sample comprised 995 students with a background of poverty, attending five public elementary schools in Rio de Janeiro State and two public universities of Ceará State, aged between 11 and 29 years old (M = 15,81; SD = 3,55), of which 54,8% (n = 522) were women. The Exploratory Factor Analysis revealed a unifactorial structure, with good reliability and convergent validity. Among the reasons mentioned for the perceived discrimination, physical appearance and socioeconomic level were the most frequent. The findings suggest the scale's adapted version presents psychometric qualities that allow its use with Brazilian adolescents and young people.

La discriminación tiene impacto negativo en la salud mental y los resultados académicos y socioemocionales de las personas. Uno de los instrumentos más utilizados para medir la frecuencia de las experiencias de discriminación es la Escala de Discriminación en la Vida Diaria. Sin embargo, esta escala aún no se ha adaptado al contexto brasileño. Por lo tanto, el objetivo de este estudio fue adaptar y validar la Escala de Discriminación Cotidiana en una muestra de adolescentes y jóvenes brasileños de nivel socioeconómico bajo y describir los motivos de discriminación más prevalentes. Se analizaron las equivalencias lingüísticas y la estructura factorial de la escala. La muestra estuvo compuesta por 995 alumnos pobres, provenientes de la Enseñanza Básica de cinco escuelas públicas del Estado de Río de Janeiro y de dos universidades públicas del Ceará, con edades comprendidas entre los 11 y los 29 años (M = 15,81, DT = 3,55), siendo el 54,8% mujeres (n = 522). El Análisis Factorial Exploratorio realizado reveló una estructura unifactorial, con buena fiabilidad y validez. Los motivos de discriminación más frecuentes fueron el aspecto físico y el nivel socioeconómico. Los resultados sugieren que la versión adaptada presenta cualidades psicométricas que permiten su uso con adolescentes y jóvenes brasileños.

The Prospective Co-Parenting Relationship Scale (PCRS) for Sexual Minority and Heterosexual People: Preliminary Validation.

The coparenting relationship begins with a process of planning and negotiation about having children. Available psychological instruments have not been adapted to sexual minority people, which compromises their ecological validity. This mixed method study aimed to adapt and validate a prospective version of the Co-Parenting Relationship Scale in a Portuguese sample of sexual minority and heterosexual adults who did not have children and who were in a dyadic relationship. In study 1, cognitive interviews were used to gather participants' reflections about the original items and the role played by the family of origin and anticipated stigma in coparenting (n = 6). In study 2, using a sample of individuals from 18 to 45 years old, two Exploratory Factor Analyses (EFA) were conducted separately for sexual minority (n = 167) and heterosexual persons (n = 198), and a Confirmatory Factor Analysis (CFA) was conducted for heterosexual persons (n = 176). Results showed underscored the importance of families of origin independent of sexual orientation. Different factorial structures for sexual minority and heterosexual persons were observed. Among sexual minority persons, the role of stigma was also highlighted. Implications for practice and research are discussed.

Resilience in the face of peer victimization and perceived discrimination: The role of individual and familial factors.

BACKGROUND: Peer victimization and discrimination are two related forms of social victimization. However, the majority of studies only focus on one form or the other. This study investigates resilience in victims of both these forms of violence. OBJECTIVE: To identify individual and family level factors that foster, or hinder, resilience in the face of both peer victimization and perceived discrimination. PARTICIPANTS: In a sample of 2975 high-school students, 22% (n = 644) met the criteria for substantial social victimization. The sample's mean age was 16.5 years, 57% were girls, 19% were in vocational courses, 12% were from an ethnic minority background, and 5% were lesbian, gay, or bisexual. METHOD: A measure of resilience was created by regressing the mean levels of current mental health, self-esteem, and life satisfaction on the frequency of lifetime peer victimization and past year perceived discrimination. Regression analyses were conducted to identify correlates of resilience considering protective and vulnerability factors, including sociodemographic information, anxious personality, empathy, coping strategies, familial optimism, and the relationship with their mother and father. RESULTS: Resilience was associated with low anxious personality, four coping strategies (active, use of humor, low self-blame, low substance use), and satisfaction with the relationship with the mother. CONCLUSIONS: Resilience is related to both behavioral and meaning-making coping strategies, personality traits, and satisfaction in relationships. This study's findings can be used to tailor interventions to foster resilience in adolescents exposed to social victimization.

Human Interleukin-1ß Profile and Self-Reported Pain Monitoring Using Clear Aligners with or without Acceleration Techniques: A Case Report and Investigational Study.

Introduction: There is a growing demand for more aesthetic, comfortable, and faster orthodontic treatments, and clear aligners emerged as a solution to fulfill this need. However, the effectiveness of clear aligners to treat complex malocclusions is yet contentious. The use of acceleration methods could improve the efficacy of clear aligners by stimulating cells' mechanobiology through numerous pathways, but this hypothesis is still poorly explored. Objective: We aimed to monitor the release profile of an inflammatory marker-the interleukin-1ß-and to evaluate its relationship with self-reported pain scores with and without the use of acceleration techniques during an orthodontic treatment requiring difficult tooth movements with clear aligners. Case Report. Here, we report a case of a 46-year-old female patient who presented functional and aesthetic complaints. Intraoral examination revealed a diminished overjet and overbite, rotation of teeth 45 and 24, absence of teeth 25, 35, and 36, buccolingual dislocation of tooth 21, a tendency to a Class III malocclusion, and a 2 mm left deviation of the lower midline. This study is divided into three stimulation phases: no stimulation, mechanical vibration stimulation, and photobiomodulation. Interleukin-1ß levels in gingival crevicular fluid samples from the pressure side of six selected teeth were evaluated at four time points after the orthodontic treatment onset. Pain monitoring in those teeth was performed using a visual analogue scale at the same time points. Results: Interleukin-1ß protein production peaked 24 h after treatment onset. Complex movements were associated with increased self-reported pain. Conclusion: Clear aligners show limitations in solving complex tooth movements, even when combined with acceleration. The development of customized and programmable stimulation microdevices integrated into "smart aligners," which could be designed to specifically stimulate the direction of movement and stimulation parameters and could constitute a solution to optimize the orthodontic tooth movement with clear aligners.

Cellular and Molecular Pathways Underlying the Nephrotoxicity of Gadolinium.

Mounting evidence on the short- and long-term adverse effects associated with gadolinium [Gd (III)]-based contrast agents used in magnetic resonance imaging have emerged in the past 3 decades. Safety issues arise from the release of Gd (III) from chelates and its deposition in tissues, which is exacerbated in patients with renal disease, because the kidney is the major excretion organ of most of these agents. This study aimed at unveiling the cellular and molecular mechanisms of nephrotoxicity of Gd (III), using an in vitro model of human proximal tubular cells (HK-2 cell line). Cell viability declined in a concentration- and time-dependent manner after exposure to GdCl3·6H2O. The estimated inhibitory concentrations (ICs) eliciting 1%-50% of cell death, after 24 h of exposure, ranged from 3.4 to 340.5 µM. At toxic concentrations, exposure to Gd (III) led to disruption of the oxidative status, mitochondrial dysfunction, cell death by apoptosis, switching to necrosis at higher levels, and autophagic activation. Disturbance of the lipid metabolism was already observed at low-toxicity ICs, with accumulation of lipid droplets, and upregulation of genes related to both lipogenesis and lipolysis. Gd (III)-exposure, even at the subtoxic IC01, increased the expression of modulators of various signaling pathways involved in the development and progression of renal disease, including inflammation, hypoxia, and fibrosis. Our results give new insights into the mechanisms underlying the nephrotoxic potential of Gd (III) and highlight the need to further clarify the risks versus benefits of the Gd (III)-based contrast agents currently in use.

Solidariedade, maturidade e ambivalência em avós e mães de crianças com deficiência: potencialidades e recursos nas trocas intergeracionais1 / Solidarity, maturity and ambivalence of grandmothers and mothers of children with disabilities: potentialities and resources in intergenerational exchanges

RESUMO: A literatura consagrou a importância de suporte e de atitudes solidárias na vida de pessoas que enfrentam adversidades. Nesse sentido, este estudo objetivou identificar e discutir o fenômeno da solidariedade intergeracional entre mães e avós de crianças com deficiência em uma amostra brasileira. Trata-se de um estudo descritivo, de caráter quantitativo. Os dados foram coletados com 76 participantes: díades de avós e mães de crianças com deficiência que apresentam dependência de adultos no cotidiano. Instrumentos de autorrelato foram administrados individualmente para apreender dimensões da relação intergeracional, de ambivalência e maturidade das mães e das avós. Os resultados indicam que a ambivalência intergeracional é a dimensão com valores mais baixos nas mães, mas uma das dimensões com valores mais elevados nas avós, juntamente à maturidade parental. Algumas implicações podem ser retiradas para a necessidade de levar em consideração a riqueza e a complexidade existente na reciprocidade das relações intergeracionais no geral e, em particular, entre cuidadoras de crianças com elevado nível de dependência. As intervenções, que visem colaborar para a coesão e bem-estar dessas famílias, devem considerar o papel desempenhado não só pela mãe e pelo pai, como cuidadores principais, mas também pelos avós, atendendo tanto ao apoio que prestam como às suas próprias necessidades de apoio, de informação e de autonomia. Estudos futuros podem tentar esclarecer, do ponto de vista qualitativo e quantitativo, essas relações diádicas, assim como introduzir outros indicadores de risco e de ajustamento adicionais, como outras pessoas que podem ser fontes de apoio, sejam ou não membros da família biológica.

ABSTRACT: Literature has established the importance of support and solidary attitudes in the lives of people facing adversity. In this sense, this study aimed to identify and discuss the phenomenon of intergenerational solidarity between mothers and grandmothers of children with disabilities in a Brazilian sample. This is a descriptive, quantitative study. Data were collected from 76 participants: dyads of grandmothers and mothers of children with disabilities who are dependent on adults in their daily lives. Self-report instruments were administered individually to apprehend dimensions of the intergenerational relationship, ambivalence and maturity of mothers and grandmothers. The results indicate that intergenerational ambivalence is the dimension with the lowest values in mothers, but one of the dimensions with the highest values in grandmothers, together with parental maturity. Some implications can be drawn from the need to take into account the richness and complexity existing in the reciprocity of intergenerational relationships in general and, in particular, between caregivers of children with a high level of dependency. Interventions aimed at contributing to the cohesion and well-being of these families must consider the role played not only by the mother and father, as the main caregivers, but also by the grandparents, attending both the support they provide and their own needs support, information and autonomy. Future studies may try to clarify, from a qualitative and quantitative point of view, these dyadic relationships, as well as to introduce other additional risk and adjustment indicators, such as other people who can be sources of support, whether or not they are members of the biological family.

Psychosocial adjustment profiles of Elementary School 6th graders: a Cluster-based analysis / Perfis de ajustamento psicossocial de estudantes do 6º ano do Ensino Fundamental: uma análise baseada em Clusters

Based on the resilience theory, this study aimed to analyze different psychosocial adjustment profiles of Elementary School 6th graders, considering risk factors (school stressors and daily discrimination), protection (social skills, family support, and school climate) and adjustment indicators (general and academic self-efficacy beliefs). A total of 448 students (between 10 and 17 years old) from public schools in the state of Rio de Janeiro (Brazil) participated. Through cluster analysis, two profiles were identified: resilient, with high levels of risk indicators and good adjustment; and vulnerable, with high levels of risk and low adjustment. The results indicated that the protective factors do not neutralize the stressful psychophysiological phenomena associated with the transition, but they mitigate the impact of the risk, increasing the coping capacity in the new context, promoting students' resilience.

Fundamentado na teoria da resiliência, este estudo teve por objetivo analisar diferentes perfis de ajustamento psicossocial de estudantes do 6º ano do Ensino Fundamental. Foram considerados fatores de risco (estressores escolares e discriminação cotidiana), proteção (habilidades sociais, suporte familiar e clima escolar) e indicadores de ajustamento (crenças de autoeficácia geral e acadêmica). Participaram 448 alunos, com idade entre 10 e 17 anos, de escolas públicas do Estado do Rio de Janeiro (Brasil). Por meio da análise de clusters, dois perfis foram identificados: resiliente, com valores altos de indicadores de risco com bom ajustamento, e vulnerável, com índices altos de risco e baixo ajustamento. Os resultados indicaram que os fatores de proteção não anulam os fenômenos psicofisiológicos estressantes associados à transição, mas amortizam o impacto do risco, aumentando a capacidade de enfrentamento diante do novo contexto, promovendo a resiliência dos alunos.

Parental Burnout and the COVID-19 Pandemic: How Portuguese Parents Experienced Lockdown Measures.

Objective: This work aimed to analyze parental burnout (PB) and establish a comparison between the times before (Wave 1) and during (Wave 2) the COVID-19 pandemic. Background: The COVID-19 pandemic brought additional stress to families. The pandemic could be particularly difficult for parents experiencing parental burnout, a condition that involves four dimensions: an overwhelming sense of exhaustion, emotional distancing from the child, saturation or a loss of fulfillment with the parental role, and a sharp contrast between how parents used to be and how they see themselves now. Method: A quasi-longitudinal research design was adopted, comparing two cross-sectional studies among Portuguese parents (N = 995), with an interval of 2 years between each wave of data collection. Participants were surveyed voluntarily through an online questionnaire located on the institutional web platform of the universities involved in the study. Multivariate analysis of covariance was used to take into account the associations among variables, alongside controlling the possible confounding effects. Results: Parents have overall higher parental burnout scores in Wave 2 than Wave 1, with increased exhaustion, emotional distancing, and contrast, but decreased saturation. Although parental burnout levels remain higher for mothers across the two Waves, the growth is greater for fathers than for mothers. Conclusion: Reconciling childcare with paid work is a stressful and new experience for many fathers. However, results suggest that even amid a crisis, some parents had the opportunity to deeply bond with their children. Implications: We expect this work to encourage stakeholders to consider proper intervention strategies to address potential parental burnout. Also, initiatives that strengthen gender equity within parenting context are needed.

IL-31 and IL-8 in Cutaneous T-Cell Lymphoma: Looking for Their Role in Itch.

The itch associated with cutaneous T-cell lymphoma (CTCL), including Mycosis Fungoides (MF) and Sézary syndrome (SS), is often severe and poorly responsive to treatment with antihistamines. Recent studies have highlighted the possible role of interleukins in nonhistaminergic itch. We investigated the role of IL-31 and IL-8 in CTCL, concerning disease severity and associated itch. Serum samples of 27 patients with CTCL (17 MF and 10 SS) and 29 controls (blood donors) were analyzed for interleukin- (IL-) 31 and IL-8; correlations with disease and itch severity were evaluated. IL-31 serum levels were higher in CTCL patients than in controls and higher in SS than in MF. Also, serum IL-31 levels were higher in patients with advanced disease compared to those with early disease, and they correlated positively with lactate dehydrogenase and beta 2-microglobulin levels, as well as with the Sézary cell count. Itch affected 67% of CTCL patients (MF: 47%; SS: 100%). Serum IL-31 levels were higher in itching patients than in controls and in patients without itching. There was no association between serum IL-8 and disease severity, nor with itching. Serum IL-8 levels correlated positively with peripheral blood leukocyte and neutrophil counts in CTCL patients. Our study suggests a role for IL-31 in CTCL-associated itch, especially in advanced disease and SS, offering a rational target for new therapeutic approaches. Increased serum IL-8 observed in some patients may be related to concomitant infections, and its role in exacerbating itch by recruiting neutrophils and promoting the release of neutrophil proteases deserves further investigation.

Interleukin 6 (rs1800795) and pentraxin 3 (rs2305619) polymorphisms-association with inflammation and all-cause mortality in end-stage-renal disease patients on dialysis.

Chronic inflammation plays an important role in the progression and outcome of chronic kidney disease (CKD). The circulating levels of the inflammatory biomarkers interleukin 6 (IL6) and pentraxin 3 (PTX3) are enhanced in CKD patients, and are associated with the progression of the disease and with higher risk for cardiovascular events, the major cause of death in CKD patients. Our aim was to study how specific polymorphisms of IL6 and PTX3 encoding genes affect the inflammatory response and outcome of end-stage renal disease (ESRD) patients on dialysis. Methodology included the analysis of two single nucleotide polymorphisms (SNP), namely the IL6 (rs1800795) polymorphism in the promoter region (-174G > C), and the PTX3 (rs2305619) polymorphism in the intron 1 (+ 281A > G), which were analyzed in ESRD patients on dialysis and in a group of heathy individuals. The allelic frequencies, genotype distribution and their association with circulating levels of the inflammatory markers C-reactive protein (CRP), IL6, growth differentiation factor 15 (GDF15) and PTX3, were determined in ESRD patients. Events of death were recorded along one year, to assess the association of the studied SNPs with all-cause mortality and the inflammatory biomarkers, in ESRD patients. Results showed that the allelic frequencies and genotype distribution for IL6 and PTX3 SNPs in the control group and ESRD patients were similar and in agreement with other European reports. For the IL6 polymorphism, we found a trend towards higher levels of high-sensitivity (hs) CRP, IL6 and PTX3 in the homozygous genotypes; the CC genotype also showed the highest levels of GDF15. The mortality rate after the 1-year follow-up was 10.4%. The CC genotype (IL6 SNP) was associated to a higher risk of mortality and deceased patients carrying this genotype also showed the highest levels of hsCRP. Regarding the studied PTX3 SNP, the AA genotype was linked to an enhanced inflammatory response, showing the highest values of hsCRP and IL6. Nevertheless, this genotype had no significant impact on the mortality rate. In conclusion, both studied SNPs seem to modulate the inflammatory response in ESRD and may, therefore, be determinant on disease progression and patients' outcome. Our data also highlights the importance of research on genetic variants that, although less frequent, may have significant biological value.

Subpopulations of High-Density Lipoprotein: Friends or Foes in Cardiovascular Disease Risk in Chronic Kidney Disease?

Dyslipidemia is a major traditional risk factor for cardiovascular disease (CVD) in chronic kidney disease (CKD) patients, although the altered lipid profile does not explain the number and severity of CVD events. High-density lipoprotein (HDL) is a heterogeneous (size, composition, and functionality) population of particles with different atherogenic or atheroprotective properties. HDL-cholesterol concentrations per se may not entirely reflect a beneficial or a risk profile for CVD. Large HDL in CKD patients may have a unique proteome and lipid composition, impairing their cholesterol efflux capacity. This lack of HDL functionality may contribute to the paradoxical coexistence of increased large HDL and enhanced risk for CVD events. Moreover, CKD is associated with inflammation, oxidative stress, diabetes, and/or hypertension that are able to interfere with the anti-inflammatory, antioxidative, and antithrombotic properties of HDL subpopulations. How these changes interfere with HDL functions in CKD is still poorly understood. Further studies are warranted to fully clarify if different HDL subpopulations present different functionalities and/or atheroprotective effects. To achieve this goal, the standardization of techniques would be valuable.

Cell-free DNA as a marker for the outcome of end-stage renal disease patients on haemodialysis.

BACKGROUND: DNA damage and inflammation are common in end-stage renal disease (ESRD). Our aim was to evaluate the levels of circulating cell-free DNA (cfDNA) and the relationship with inflammation, anaemia, oxidative stress and haemostatic disturbances in ESRD patients on dialysis. By performing a 1-year follow-up study, we also aimed to evaluate the predictive value of cfDNA for the outcome of ESRD patients. METHODS: A total of 289 ESRD patients on dialysis were enrolled in the study: we evaluated cfDNA, haemogram, serum iron, hepcidin, inflammatory and oxidative stress markers, and haemostasis. Events and causes of deaths were recorded throughout the follow-up period. RESULTS: ESRD patients, as compared with controls, presented significantly higher levels of cfDNA, hepcidin, and inflammatory and oxidative stress markers, and significantly lower values of iron and anaemia-related haemogram parameters. The all-cause mortality rate was 9.7%; compared with alive patients, deceased patients (n = 28) were older and presented significantly higher values of inflammatory markers and of cfDNA, which was almost 2-fold higher. Furthermore, cfDNA was the best predictor of all-cause mortality and cardiovascular mortality in ESRD patients, in both unadjusted and adjusted models for basic confounding factors in dialysis. CONCLUSIONS: Our data show cfDNA to be a valuable predictive marker of prognosis in ESRD patients on dialysis treatment; high levels of cfDNA were associated with a poor outcome.