Vaginal hysterectomy for the treatment of low-risk endometrial cancer: Surgical technique, costs, and perioperative and oncologic results.

OBJECTIVES: This study aimed to describe an operative technique for vaginal hysterectomy (VH) and assess the costs, perioperative, and oncological outcomes for this procedure when used in the treatment of patients with low-risk endometrial cancer (LREC). METHODS: A retrospective analysis of medical records was conducted on patients who underwent VH to treat precursor and invasive endometrial lesions between April 2019 and November 2021 at a single center in São Paulo, Brazil. RESULTS: Thirty-four patients met the inclusion criteria. The mean patient age was 61.9 years, and the mean body mass index (BMI) was 34. Obese patients (BMI ≥ 30) accounted for 77% of the sample. Preoperative functional capacity measures were Eastern Cooperative Oncology Group (ECOG) 0-1 and ECOG-2 for 91% and 9% of the patients, respectively. The mean operative time and length of hospital stay were 109 min and 1.2 days, respectively. Four patients had a conversion of the surgical route to laparotomy. No major intraoperative complications were observed. Patients who underwent surgical conversion had a greater uterine volume (227 versus 107 mL, p = 0.006) and longer operative time (177 versus 96 min, p = 0.001). The total cost associated with VH was, on average, US$ 2058.77 (R$ 10,925.91), representing 47% of the cost associated with non-vaginal routes. Twenty-eight patients received a definitive diagnosis of endometrial carcinoma; of these, three received adjuvant radiotherapy. The mean follow-up period was 34.6 months for the patients diagnosed with cancer. One case of disease recurrence occurred 16.6 months after surgery, with one death at 28.6 months of follow-up. CONCLUSIONS: These findings suggest that VH could be a feasible and cost-effective alternative for selected patients with LREC in low-resource settings.

First birth after uterine transposition in low-volume lymph node metastasis of cervical cancer: A long journey for success.

Locally advanced cervical cancer poses a significant challenge to fertility-sparing treatments. Pelvic radiotherapy impairs reproductive potential owing to ovarian, uterine, and endometrial side effects. This study presents a literature review of the main fertility-sparing therapeutic alternatives for locally advanced cervical cancer and a case report of the first childbirth following uterine transposition for gynecological malignancies.

Does sentinel node mapping impact morbidity and quality of life in endometrial cancer?

OBJECTIVES: To evaluate the prevalence of post-operative complications and quality of life (QoL) related to sentinel lymph node (SLN) biopsy vs systematic lymphadenectomy in endometrial cancer. METHODS: A prospective cohort included women with early-stage endometrial carcinoma who underwent lymph node staging, grouped as follows: SLN group (sentinel lymph node only) and SLN+LND group (sentinel lymph node biopsy with addition of systematic lymphadenectomy). The patients had at least 12 months of follow-up, and QoL was assessed by European Organization for Research and Treatment of Cervical Cancer Quality of Life Questionnaire 30 (EORTC-QLQ-C30) and EORTC-QLQ-Cx24. Lymphedema was also assessed by clinical evaluation and perimetry. RESULTS: 152 patients were included: 113 (74.3%) in the SLN group and 39 (25.7%) in the SLN+LND group. Intra-operative surgical complications occurred in 2 (1.3%) cases, and all belonged to SLN+LND group. Patients undergoing SLN+LND had higher overall complication rates than those undergoing SLN alone (33.3% vs 14.2%; p=0.011), even after adjusting for confound factors (OR=3.45, 95% CI 1.40 to 8.47; p=0.007). The SLN+LND group had longer surgical time (p=0.001) and need for admission to the intensive care unit (p=0.001). Moreover, the incidence of lymphocele was found in eight cases in the SLN+LND group (0 vs 20.5%; p<0.001). There were no differences in lymphedema rate after clinical evaluation and perimetry. However, the lymphedema score was highest when lymphedema was reported by clinical examination at 6 months (30.1 vs 7.8; p<0.001) and at 12 months (36.3 vs 6.0; p<0.001). Regarding the overall assessment of QoL, there was no difference between groups at 12 months of follow-up. CONCLUSIONS: There was a higher overall rate of complications for the group undergoing systematic lymphadenectomy, as well as higher rates of lymphocele and lymphedema according to the symptom score. No difference was found in overall QoL between SLN and SLN+LND groups.

Cervical Cancer-Related Knowledge, Attitudes, Practices and Self-Screening Acceptance Among Patients, Employees, and Social Media Followers of Major Brazilian Hospital.

BACKGROUND: Brazil has a high burden of cervical cancer, even though it is preventable, traceable and treatable. Hence, this study evaluated levels of knowledge, attitudes and practices (KAP) related to cervical cancer screening and diagnosis and acceptance of self-screening techniques among women aged 24 and greater. METHODS: A cross-sectional KAP survey was administered to n = 4206 women and spanned questions relating to cervical cancer, HPV, speculum, Pap test and colposcopy. Questionnaire was disseminated through a major hospital's social media platforms, intranet and gynecologic-oncology clinics. Logistic regressions evaluated associations between sociodemographic characteristics and knowledge, attitudes, and preventative behaviors against cervical cancer. Participants indicated willingness to try DNA-HPV self-sampling and cervix self-visualization (self-colposcopy). FINDINGS: Participants were mostly white individuals (70.5%) with higher education and from social classes A and B. They demonstrated superior levels of KAP than described in the literature, with over 57.8% having answered 80+% of questions correctly. KAP scores were predicted by social class, educational attainment, race, history of premalignant cervical lesions and geographic location. About 80% and 63% would be willing to try DNA-HPV self-sampling and cervix self-visualization, respectively. Interest in self-screening was associated with adequate attitude (OR = 1.85) and inadequate practice (OR = .83). INTERPRETATION: Adequate KAP are fundamental for the successful implementation of a self-screening program. Participants were interested in methods that provide them with greater autonomy, control and practicality. Self-screening could address barriers for under-screened women such as shame, discomfort, distance from clinics and competing commitments, enabling Brazil to reach the WHO's cervical cancer elimination goals. It could also decrease excess medical intervention in over-screened populations by promoting shared decision-making.

Sentinel lymph node mapping versus sentinel lymph node mapping with systematic lymphadenectomy in endometrial cancer: an open-label, non-inferiority, randomized trial (ALICE trial).

BACKGROUND: Growing evidence suggest that sentinel lymph node (SLN) biopsy in endometrial cancer accurately detects lymph node metastasis. However, prospective randomized trials addressing the oncological outcomes of SLN biopsy in endometrial cancer without lymphadenectomy are lacking. PRIMARY OBJECTIVES: The present study aims to confirm that SLN biopsy without systematic node dissection does not negatively impact oncological outcomes. STUDY HYPOTHESIS: We hypothesized that there is no survival benefit in adding systematic lymphadenectomy to sentinel node mapping for endometrial cancer staging. Additionally, we aim to evaluate morbidity and impact in quality of life (QoL) after forgoing systematic lymphadenectomy. TRIAL DESIGN: This is a collaborative, multicenter, open-label, non-inferiority, randomized trial. After total hysterectomy, bilateral salpingo-oophorectomy and SLN biopsy, patients will be randomized (1:1) into: (a) no further lymph node dissection or (b) systematic pelvic and para-aortic lymphadenectomy. MAJOR INCLUSION AND EXCLUSION CRITERIA: Inclusion criteria are patients with high-grade histologies (endometrioid G3, serous, clear cell, and carcinosarcoma), endometrioid G1 or G2 with imaging concerning for myometrial invasion of ≥50% or cervical invasion, clinically suitable to undergo systematic lymphadenectomy. PRIMARY ENDPOINTS: The primary objective is to compare 3-year disease-free survival and the secondary objectives are 5-year overall survival, morbidity, incidence of lower limb lymphedema, and QoL after SLN mapping ± systematic lymphadenectomy in high-intermediate and high-risk endometrial cancer. SAMPLE SIZE: 178 participants will be randomized in this study with an estimated date for completing accrual of December 2024 and presenting results in 2027. TRIAL REGISTRATION NUMBER: NCT03366051.

Physicians' and nurses' perspective on chronic disease care practices in Primary Health Care in Brazil: a qualitative study.

BACKGROUND: Primary health care-oriented systems provide better healthcare, especially for chronic diseases. This study analyzed the perspectives of physicians and nurses performing care for patients with chronic diseases in Primary Health Care in a Brazilian city. METHODS: A qualitative study was conducted in Vitória da Conquista, Bahia, Brazil, using semi-structured interviews with five physicians and 18 nurses. The interview included questions from an analytical matrix based on three dimensions of healthcare practices: organizational, technical care, and biopsychosocial, following a deductive approach. The interviews were fully transcribed and analyzed using a thematic categorical approach. RESULTS: The results indicated that the provision of chronic care occurs in a comprehensive way. Potentialities were identified in the diversification of access, offer of care actions and technologies, integration of teamwork, and bringing together social networks to foster autonomy and self-care. Weaknesses were mostly related to the high number of people in the teams, follow-up of several cases, high turnover of support teams, low integration of Primary Health Care with other levels, difficulties in intersectoral articulation and family participation in care. CONCLUSION: The multidimensional assessment of health care practices aimed at individuals with chronic noncommunicable diseases was useful to portray the strengths and weaknesses of the services. It also ratifies the need to consider the importance of and investment in primary health care by offering the necessary technical, political, logistical and financial support to the units, to ensure the sustainability of the actions by nurses, doctors and entire team.

Acute Exposure to Biogenic Nanosilver Produced from Fusarium oxysporum in a Neotropical Fish.

Biogenic nanosilver (bNAg) has emerged as a potentially less toxic alternative to synthetic nanosilver. However, no studies have evaluated its effects on a fish species from the Neotropical region. Thus, our aim was to evaluate the effects of a bNAg on the Neotropical fish Prochilodus lineatus. For this purpose, after 24 h of exposure to 100 µg L-1 of bNAg, blood samples were collected to evaluate hematological, genotoxic, and plasma parameters. Gills and liver were sampled to evaluate biomarkers of oxidative stress and brain samples were used to assess neurotoxicity. The fish presented hyperglycemia, an increased number of erythrocytes, a reduction in antioxidant enzyme activity in both tissues evaluated, and a decrease in lipid peroxidation in the gills. We concluded that P. lineatus is a sensitive species to this nanoparticle, since it presented alterations in several biomarkers after an acute exposure.

Tricky Diagnosis and Robot-laparoscopic Surgical Approach to Disseminated Peritoneal Leiomyomatosis.

STUDY OBJECTIVE: To show the challenging diagnosis of, and safe robotic surgical approach to, a rare case of disseminated peritoneal leiomyomatosis (DPL). DESIGN: A clinical case shown by a sequential demonstration of investigation, diagnosis, and surgical approach, with narrated video footage. SETTING: DPL is a rare disease, with only a little more than 150 cases reported in the literature [1]. It is defined by subperitoneal proliferation of benign smooth muscle cell nodules, macroscopically mimicking peritoneal carcinomatosis [2]. The etiology remains unclear, but different hypotheses have been put forward, such as subperitoneal mesenchymal stem cell metaplasia and iatrogenic origin after myomectomy [3]. Despite its usual benign behavior, DPL can rarely present with malignant degeneration, and therefore a complete resection of multiple lesions is recommended [4]. This case involves a 45-year-old patient presenting with dysmenorrhea, abdominal pain, and major abnormal uterine bleeding, requiring previous blood transfusion and no response after 2 years of clinical treatment. She had a previous cesarean delivery, with no reproductive desire at present and no history of other pelvic surgeries. Pelvic examination showed an enlarged mobile uterus at the height of the pubic symphysis, and both ultrasonography and magnetic resonance imaging confirmed an enlarged uterus due to multiple myomas. INTERVENTIONS: (1) Diagnostic laparoscopy with implant biopsies and uterine curettage for investigation of DPL and its differential diagnoses, followed by robot-assisted laparoscopic approach, with key strategies for a safe performance. (2) Radical hysterectomy with bilateral salpingo-oophorectomy, omentectomy, and wide pelvic peritoneal resection were performed. (3) For this complex procedure, the identification and preservation of important landmarks and pelvic anatomy were mandatory, as well as removal of all surgical specimens in monobloc. Final pathology report: disseminated leiomyomatosis with no evidence of malignancy. The patient had no complications after surgery and was discharged on the second postoperative day with mild abdominal pain. CONCLUSION: DPL diagnosis can be tricky owing to its macroscopic similarity to peritoneal carcinomatosis and the difficulty of identification in imaging examinations. Moreover, the robotic platform can be a helpful and safe tool for the surgical treatment of DPL and complete resection of all peritoneal lesions.

A human scFv antibody that targets and neutralizes high molecular weight pathogenic amyloid-ß oligomers.

Brain accumulation of soluble oligomers of the amyloid-ß peptide (AßOs) is increasingly considered a key early event in the pathogenesis of Alzheimer's disease (AD). A variety of AßO species have been identified, both in vitro and in vivo, ranging from dimers to 24mers and higher order oligomers. However, there is no consensus in the literature regarding which AßO species are most germane to AD pathogenesis. Antibodies capable of specifically recognizing defined subpopulations of AßOs would be a valuable asset in the identification, isolation, and characterization of AD-relevant AßO species. Here, we report the characterization of a human single chain antibody fragment (scFv) denoted NUsc1, one of a number of scFvs we have identified that stringently distinguish AßOs from both monomeric and fibrillar Aß. NUsc1 readily detected AßOs previously bound to dendrites in cultured hippocampal neurons. In addition, NUsc1 blocked AßO binding and reduced AßO-induced neuronal oxidative stress and tau hyperphosphorylation in cultured neurons. NUsc1 further distinguished brain extracts from AD-transgenic mice from wild type (WT) mice, and detected endogenous AßOs in fixed AD brain tissue and AD brain extracts. Biochemical analyses indicated that NUsc1 targets a subpopulation of AßOs with apparent molecular mass greater than 50 kDa. Results indicate that NUsc1 targets a particular AßO species relevant to AD pathogenesis, and suggest that NUsc1 may constitute an effective tool for AD diagnostics and therapeutics.

Driving after alcohol consumption among residents of Northeastern Brazil: National Health Survey 2019.

OBJECTIVE: To estimate the prevalence of factors associated with drinking and driving in Northeastern Brazil. METHODS: This was a cross-sectional study conducted with participants from the 2019 National Health Survey, aged ≥ 18 years; the analysis of the association between sociodemographic variables and the outcome, stratified by sex, was performed using Poisson regression. RESULTS: The prevalence of drinking and driving was 21.0% ( 95%CI 19.9;23.2), with 24.6% ( 95%CI 22.7;26.5), in males and 10.1 % ( 95%CI 7.9;12.7), in females (p-value < 0.001); among men, younger age groups (PR = 1.70 - 95%CI 1.29;2.24), higher household income (PR = 1.74 - 95%CI 1.33;2.28), rural residence (PR = 1.48 - 95%CI 1.26;1.74) and motorcycle riding (PR = 1.29 - 95%CI 1.05;1.58) were associated with the event, while no association was observed among women. CONCLUSION: Prevalence of drinking and driving was high in the Northeast region, especially among the male population; preventive measures targeting this group and intensified enforcement are necessary. MAIN RESULTS: The prevalence of drinking and driving was high, significantly greater in males when compared to females; positive associations between sociodemographic variables and the event were observed only in the male population. IMPLICATIONS FOR SERVICES: Intersectoral actions, involving health services and regulatory bodies, are essential to reduce the habit of drinking and driving, especially among males, in addition to promoting a safer road environment in the Northeast region. PERSPECTIVES: It is necessary to strengthen enforcement measures for alcohol consumption and driving, especially in rural areas and among motorcycle riders, in addition to implementing traffic education programs and awareness campaigns.

Mortality trends and years of potential life lost due to suicide in adolescents.

OBJECTIVE: To assess the trend in mortality rates and years of potential life lost (YPLL) due to suicide among adolescents in Northeast Brazil. METHODS: This is an ecological time series study, with secondary data from 2011 to 2020 from the Mortality Information System for adolescents aged 10 to 19 years in the Northeast region of Brazil. Groups of causes from the 10th Revision of the International Classification of Diseases were included: X60-X84 (intentionally self-inflicted injuries), Y10-Y19 (poisoning of undetermined intent), and Y87 (sequelae of intentional self-harm). Mortality coefficients and frequency distribution by sociodemographic variables, place of occurrence, and method of suicide were estimates. YPLL were estimated by gender and age. Joinpoint regression analysis was used, and the annual percentage change (APC) was determined with 95% confidence intervals. RESULTS: A total of 2,410 deaths were recorded, with a predominance of adolescents aged between 15 and 19, males, of mixed-race, low schooling, and home was the main place of occurrence. The trend in the death rate was increasing in the Northeast (APC: 3.6%; p = 0.001), in girls aged 10 to 14 (APC: 8.7%; p = 0.003), in boys aged 15 to 19 (APC: 4.6%; p = 0.002) and in Bahia (APC: 8.1%; p = 0.012). Hanging/strangulation was the main method adopted by both sexes. The YPLL due to suicide were 11,110 in 2011 and 14,960 in 2020. CONCLUSION: The precociousness of suicide committed by girls and the increase in mortality among older adolescents are noteworthy, and specific preventive measures need to be adopted for these groups in order to reduce this preventable cause of death.

Developing a Nomogram for Prioritizing Hysteroscopy in Endometrial Cancer Diagnosis: A Case-Control Study.

(1) Background: The pandemic led to significant healthcare disruptions, resulting in postponed surgeries and extended waiting times for non-urgent treatments, including hysteroscopies essential for diagnosing endometrial cancer. This study aims to formulate a risk stratification model to enhance the prioritization of hysteroscopy procedures in Brazil; (2) Methods: A case-control study was conducted at Vila Santa Catarina Hospital in São Paulo, analyzing the medical records of 2103 women who underwent hysteroscopy between March 2019 and March 2022. We used bivariate analysis and multivariate linear regression to identify risk factors associated with endometrial cancer and formulate a nomogram; (3) Results: The findings revealed a 5.5% incidence of pre-invasive and invasive endometrial disease in the study population, with an average waiting time of 120 days for hysteroscopy procedures. The main risk factors identified were hypertension, diabetes, postmenopausal bleeding, and obesity; (4) Conclusions: This research highlights the urgent need for efficient prioritization of hysteroscopy procedures in the wake of the pandemic. The developed nomogram is an innovative tool for identifying patients at higher risk of endometrial cancer, thus facilitating timely diagnosis and treatment and improving overall patient outcomes in a strained healthcare system.

Prepregnancy Obesity and Breastfeeding in the First Month of Life: A Birth Cohort.

Objective: This study aimed to investigate the association between prepregnancy obesity and disruption of exclusive breastfeeding (EBF) within the first month of life. Materials and Methods: This was a prospective cohort study conducted among Brazilian mothers and their babies born between February and December 2017. Research was conducted in all maternity hospitals in Vitória da Conquista, Brazil. Data collection started in the maternity hospitals of the city and, subsequently, an interview was conducted during a home visit on the 30th day of the child's life. Survival analysis was performed using Kaplan-Meier curves and a log rank test was applied to compare the curves. The association between independent variables and the response variable was assessed using Cox regression, following the conceptual model created for the study. Results: The study analyzed 329 pairs of mothers and babies. The prevalence of prepregnancy obesity was 12%. The prevalence of EBF disruption in the first month of life was 41.1% in nonobese mothers (confidence interval [95% CI]: 35.3-46.9) and 52.6% in obese mothers (95% CI: 36.3-68.4), with a shorter survival time among mothers with prepregnancy obesity (log rank p < 0.05). The risk of EBF disruption in the first month of life was 83% higher among mothers with prepregnancy obesity, after adjusting for confounding variables-demographic, socioeconomic, prenatal maternal data, and childbirth variables (hazard ratio = 1.84; 95% CI: 1.08-3.11). Conclusions: We observed an association between pregestational obesity and disruption of EBF in the first month of life. This finding reinforces the need for a thorough professional approach to the practice of breastfeeding in this population in the prenatal period as well as early puerperium.

Cadmium effects on the freshwater teleost Prochilodus lineatus: Accumulation and biochemical, genotoxic, and behavioural biomarkers.

In order to evaluate the effects of Cd, juveniles of the Neotropical fish Prochilodus lineatus were exposed to 1 and 10 µg L-1 Cd, for 24 and 96 h. Fish exposed to Cd showed metal accumulation in the gills, kidney, and liver, an increase in DNA damage in erythrocytes, and an increase in lipid peroxidation (LPO) in the kidney. Cd exposure also caused a reduction in catalase activity, metallothionein induction, and LPO in the liver. Cd stimulated the swimming activity of exposed fish, resulting in longer swimming times and distances travelled, especially for the shortest exposure time. Changes in acetylcholinesterase activity (AChE) in the muscle and brain are probably related to these behavioural responses. These results show that Cd affects the functioning of several organs in P. lineatus, which is indicated by the genotoxic damage and changes in the AChE and swimming pattern of the exposed fish.

Short-term outcomes after an enhanced recovery after surgery protocol in abdominal hysterectomies for leiomyomas in a teaching hospital.

OBJECTIVE: To compare the perioperative outcomes of patients undergoing abdominal hysterectomies for leiomyomas before and after the implementation of an enhanced recovery after surgery (ERAS) protocol in a teaching hospital. METHODS: This prospective cohort study compared a patient group from a historical series (pre-ERAS) with another group after ERAS implementation. Fasting time, length of hospital stay, complications, readmission rates, and procedure-related hospital costs were analyzed. RESULTS: Altogether, 187 patients were included in the analysis: 92 (49.2%) and 95 (50.8%) in the pre-ERAS and ERAS groups, respectively. Both groups had similar clinical characteristics. We observed reductions in surgical outcome findings: fasting time (13.9 to 6.7 h, P < 0.001), bladder catheter usage (21.1 to 10.9 h, P < 0.001), infection rates (20.7% to 5.3%, P = 0.002), length of stay (57.5 to 37.6 h), and 38.4% of the total estimated mean cost per procedure (USD $1570.8 to USD $967.2, P < 0.001) in the pre-ERAS and ERAS groups, respectively. Hospital readmission rates (P > 0.99) did not increase. CONCLUSION: ERAS protocol implementation for hysterectomies involving uterine leiomyomas reduced the length of hospital stay, surgical site infection rates, and hospital costs. A mean savings of USD $603.6 per procedure would allow 62.4% more hysterectomies to be performed.

[Introduction of ultra-processed foods and associated factors among children under six months of age in the Southwest of the state of Bahia, Brazil]. / Introdução de alimentos ultraprocessados e fatores associados em crianças menores de seis meses no sudoeste da Bahia, Brasil.

The scope of this study was to assess the prevalence and associated factors with the introduction of ultra-processed food (UPF) among children under six months of age living in the southwest of Bahia state. This is an excerpt from a prospective cohort study conducted with pairs of mothers/babies. The introduction of UPF was defined by the intake of at least one UPF before the age of six months. Socioeconomic, maternal, paternal, gestational, and child-related information was gathered by the application of questionnaires. To analyze the factors associated with the outcome, Poisson regression was performed according to a hierarchical model. P-value<0.05 and 95% confidence interval are considered. A total of 300 mother/baby pairs were evaluated. Before 6 months, 31.3% of children have already received UPF. With greater introduction of cookies/biscuits (23.3%) and yogurt (14.3%). The introduction of UPF before six months of age was higher among families with lower income (p=0.038), lower maternal education (p=0.031), lower maternal (p=0.017) and paternal (p=0.013) age, among children who had cow's milk <6 months (p<0.001) and tea <30 days (p=0.005). The results demonstrate the need for interventions aimed at reducing the introduction of UPF, especially for low-income families, with less education and among younger parents.

O objetivo do estudo foi avaliar a frequência e os fatores de risco para a introdução de alimentos ultraprocessados (AUP) em crianças menores de seis meses residentes em um município do sudoeste da Bahia. Trata-se de um recorte de um estudo coorte prospectiva realizado com duplas de mães/bebês. A introdução de AUP foi definida pela ingestão de pelo menos um AUP antes dos seis meses de vida. As informações socioeconômicas, maternas, paternas, gestacionais e relacionadas a criança foram obtidas por meio da aplicação de questionários. Para análise dos fatores associados ao desfecho foi realizada regressão de Poisson de acordo com um modelo hierárquico. Foram avaliadas 300 duplas de mães/bebês. Antes dos 6 meses, 31,3% das crianças já haviam recebido AUP. Houve maior frequência de introdução de bolacha/biscoito (23,3%) e petit suísse (14,3%). A introdução de AUP antes dos seis meses de vida foi maior entre famílias com menor renda (p=0,038), menor escolaridade materna (p=0,031), menor idade materna (p=0,017) e paterna (p=0,013), em criança que receberam leite de vaca antes dos 6 meses (p<0,001) e chá antes dos 30 dias (p=0,005). Os resultados demonstram a necessidade de intervenções voltadas para redução da introdução de AUP, principalmente para famílias de baixa renda, com menor grau de instrução e entre pais mais jovens.

Can Lemna minor mitigate the effects of cadmium and nickel exposure in a Neotropical fish?

We aimed to evaluate if Lemna minor can mitigate the observed effects of cadmium (Cd) and nickel (Ni) exposure in Prochilodus lineatus. Fish were exposed for 96 h to 20 µg L-1 of Cd, 1.5 mg L-1 of Ni, or to a mixture of these two metals. In all tests, one group was exposed to the metals with duckweed on the water surface, and other group was exposed only to the metals, without plants. After each exposure, samples of P. lineatus tissues were collected to evaluate multiple biomarkers. Duckweed prevented bioaccumulation in some fish tissues and attenuated changes in acetylcholinesterase activity, increases in erythrocytic nuclear abnormality frequency, and hyperglycemia. However, the changes in plasma ion concentrations, reduction in activity of ion transport enzymes, and histological damage were not mitigated. Therefore, we concluded that L. minor partially attenuates the effects caused by Cd and Ni exposure.

Acute Response to Capsiate Supplementation at Rest and during Exercise on Energy Intake, Appetite, Metabolism, and Autonomic Function: A Randomized Trial.

OBJECTIVE: The purpose of the present study was to examine the effect of capsiate supplementation on energy intake, self-reported appetite-related sensations, energy expenditure, fat oxidation, and autonomic parameters with and without an exercise intervention. METHODS: Thirteen healthy men completed four randomized trials: two trials for the control condition (without exercise), one with capsiate supplementation (CTRLcap) and one with a placebo (CTRLpla), and two trials for the exercise condition, one with capsiate supplementation (EXcap) and one with placebo (EXpla). Exercise sessions were performed 150 min after the consumption of a standardized breakfast, and supplementation 115 min after consumption of breakfast. An ad libitum buffet was offered 200 min following the completion of the standardized breakfast, and energy intake (EI) and relative energy intake (REI) (relative energy intake = energy intake - energy expenditure related to exercise) were evaluated. RESULTS: There were no significant effects on EI, self-reported appetite sensations, fat oxidation, and energy expenditure. REI was reduced in conditions involving EX when compared to CTRL. A low-frequency to high-frequency ratio for heart rate variability was higher in CTRLcap (1.6 ± 1.1) vs. CTRLpla (1.2 ± 0.9) (p = 0.025; d = 0.39). CONCLUSION: Acute capsiate supplementation combined with aerobic exercise has limited effects on the examined variables (EI, REI, fat oxidation, energy expenditure, and autonomic parameters), while changes in the autonomic nervous system function in the absence of exercise may have occurred without influencing other variables. CLINICAL TRIAL REGISTRATION: ensaiosclinicos.gov.br number, RBR-5pckyr https://ensaiosclinicos.gov.br/rg/RBR-5pckyr.