Blood pressure variation and ultra-processed food consumption in children with obesity.

To investigate the influence of ultra-processed food (UPF) consumption on systolic (SBP) and diastolic (DBP) blood pressure in children with obesity, using dietary and urinary markers. We conducted a secondary analysis of a randomized clinical trial involving children with obesity, aged 7 to 12 years. Over a period of six months, the children and their guardians attended monthly individual consultations and educational activities aimed at promoting a reduction in UPF consumption. During each visit, measurements of blood pressure, body weight, height, and 24-h dietary recall were recorded. Additionally, spot urine samples were collected at baseline, and at the second and fifth-month follow-ups. A total of 96 children were included in the analysis. Energy intake, UPF intake and blood pressure showed a quadratic pattern of change, with a decrease in the first two months and an increase thereafter. There was an association between UPF consumption and DBP. The intake of UPF was correlated with the urinary sodium-to-potassium (Na/K) ratio (r = 0.29; p = 0.008) and the dietary Na/K ratio (r = 0.40; p < 0.001). For every 100 g increase in UPF, DBP increased by 0.28 mmHg (p-value = 0.01). After further adjustment for changes in body mass index (BMI), and physical activity, the increase in DBP was 0.22 mmHg.    Conclusion: Our findings indicate that reducing UPF consumption may have an impact on blood pressure in children with obesity. Additional adjustment for BMI and physical activity did not influence the results. Therefore, reducing UPF consumption can be considered as a strategy against hypertension. What is Known: • Ultra-processed food consumption is associated with an increased risk of cardiovascular disease; however, this evidence is still limited in children. • Intake of calories from ultra-processed food in relation to the total calories is increasing worldwide. What is New: • Ultra-processed food consumption has an effect on the diastolic blood pressure, independent of changes in weight. • The intake of ultra-processed food was correlated to the dietary sodium-to-potassium ratio (r = 0.40; p < 0.001).

A multicomponent family intervention, combined with salt reduction for children with obesity: a factorial randomized study protocol.

BACKGROUND: Clinical trials to treat childhood obesity show modest results, weight regain and high dropout rates. Children with obesity often live in families with habits that contribute to unhealthy weight gain. This study will test whether a family intervention with a Brazilian-adapted Planetary Healthy Diet (PHD) and reduced portion sizes, along with increased physical activity and reduced sedentary behavior, can reduce excessive weight gain. The protocol promotes the intake of in natura products and water and reduces ultra-processed foods, sugar, and sodium. It encourages family lifestyle changes and physical activities, with randomized allocation to experimental and control groups. The responsible family member will be evaluated during follow-up. The control group will receive a print of the Brazilian dietary guideline. METHODS: A factorial crossover design will also allocate families to receive reduced sodium salt plus anti-inflammatory herbs and a placebo salt. Both the control and intervention groups will be randomly assigned to the sequence of both salts. The approach aims to reduce body weight expectations and evaluate salt's impact on blood pressure. It includes a 1-month intervention, 1-month washout, and 1-month intervention with monthly clinic visits and teleservice by health professionals. The primary outcomes will be the variation in the Body Mass Index (BMI) of the children. BMI and the variation in the blood pressure of the pair (child/mother or father) as well as waist circumference (WC) and waist-to-height ratio (WHtR) will also be measured. DISCUSSION: The project will test the effectiveness of the use of the recommendations of the PHD, physical activity and a salt-reduced sodium. The results of the present study will allow the refinement of interventions aimed at the treatment of childhood obesity and may help develop guidelines for the treatment of obesity in Brazilian children. TRIAL REGISTRATION: The study is registered in the Brazilian Registry of Clinical Trials (RBR-10 mm62vs). Registered 10 February 2023.

Influence of internal migration on body mass index: Results of the ELSA-Brasil study.

OBJECTIVES: To investigate the association between internal migration and body mass index (BMI) in the adult population with data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) and to determine whether the association differs by the urban hierarchical levels (or influence regions) of Brazilian municipalities. METHODS: Baseline data from 13 084 participants aged 35 to 74 (2008-2010) in the ELSA-Brasil were analyzed. A migrant was defined as an individual whose municipality of residence at the beginning of schooling (origin) was different from the municipality of residence at the study baseline (destination). The origin and destination municipalities were classified by urban hierarchical levels, or influence regions, and migration was categorized as nonmigrant, stable migrant, downward migrant, or upward migrant. RESULTS: Of the ELSA-Brasil participants, 51% were migrants. Using gamma regression models, it was observed that for women and men, upward migration was associated with lower mean BMI after adjusting for age, mother's education level, participant's education level, and income. Downward migration, on the other hand, was associated with the highest mean BMI, but this result was statistically significant only for women. CONCLUSION: These findings highlight the role of environmental factors on nutritional status, noting that the effects on BMI may be positive or negative, depending on the trajectory of displacements between origin and destination.

Cancer stemness in Wnt-driven mammary tumorigenesis.

Wnt signaling plays a central role in mammary stem cell (MaSC) homeostasis and in breast cancer. In particular, epigenetic alterations at different members of the Wnt pathway have been identified among triple-negative, basal-like breast cancers. Previously, we developed a mouse model for metaplastic breast adenocarcinoma, a subtype of triple-negative breast cancer, by targeting a hypomorphic mutations in the endogenous Apc gene (Apc (1572T/+)). Here, by employing the CD24 and CD29 cell surface antigens, we have identified a subpopulation of mammary cancer stem cells (MaCSCs) from Apc (1572T/+) capable of self-renewal and differentiation both in vivo and in vitro. Moreover, immunohistochemical analysis of micro- and macrolung metastases and preliminary intravenous transplantation assays suggest that the MaCSCs underlie metastasis at distant organ sites. Expression profiling of the normal and tumor cell subpopulations encompassing MaSCs and CSCs revealed that the normal stem cell compartment is more similar to tumor cells than to their own differentiated progenies. Accordingly, Wnt signaling appears to be active in both the normal and cancer stem cell compartments, although at different levels. By comparing normal with cancer mouse mammary compartments, we identified a MaCSC gene signature able to predict outcome in breast cancer in man. Overall, our data indicate that constitutive Wnt signaling activation affects self-renewal and differentiation of MaSCs leading to metaplasia and basal-like adenocarcinomas.

Income and education level trajectories and changes in the daily consumption of vegetables after thirteen years of follow-up: the Pró-Saúde Study.

OBJECTIVE: This study aimed to examine whether education level and income trajectories influence vegetable consumption changes over 13 years among civil servants at different campuses of a university in the state of Rio de Janeiro, Brazil. METHODS: Vegetable intake frequency (daily and non-daily consumption), income (per capita), and education level (maintenance of low schooling/ upward mobility/maintenance of high schooling) were assessed at baseline (1999) and in the fourth wave (2011-12) of the Pró-Saúde (Pro-Health) cohort study. A total of 2,381 participants were analyzed. The association between educational and income trajectories and variation in vegetable consumption was assessed via crude and age-adjusted generalized linear models, stratified by sex. RESULTS: Men in upward educational mobility showed a 0.5% increase in vegetable consumption (p=0.01), while women in this group demonstrated a 2.5% increase (p=0.05). Adjusted models showed that women who reduced their income had a lower likelihood of consuming vegetables (odds ratio [OR] 0.93; 95% confidence interval [CI] 0.89-0.97). CONCLUSIONS: The findings highlight the influence of social inequalities on vegetable consumption in adults.

Treatment of childhood obesity based on the reduction of ultra-processed foods plus energy restriction: A randomised controlled trial based on the Brazilian guidelines.

Reducing ultra-processed foods (UPF) improves diet quality and may curb energy consumption. This study aimed to compare an intervention based on the reduction of UPF, according to the Dietary Guideline for the Brazilian Population (DGBP), with and without advice on energy intake. A parallel and randomised controlled trial was carried out with children with obesity from 7 to 12 years old. Both control (CG) and intervention groups (IG) participated monthly in 6 standardised educational activities based on the 10 steps of the DGBP. An individualised food plan was also provided to the IG. The rate of change for body mass index (BMI), waist circumference, body weight, and UPF consumption were investigated based on mixed-effect models. At the end of the study, the BMI declined in the IG (Δ = -0.27 kg/m2) compared to the CG (Δ = + 0.53 kg/m2) (p = .0002). Both groups showed a decline in grams of UPF until the fourth month and a gradual increase in the following months. Combining the qualitative approach of the DGBP with counselling on energy restriction through the diet plan proved to be effective in reducing childhood obesity. Clinical Trial Registration: This trial is registered at the Brazilian Registry of Clinical Trials (REBEC), under the RBR-3st5sn registry, available at http://www.ensaiosclinicos.gov.br/rg/RBR-3st5sn/. The datasets generated by the current study are not publicly available but are available from the corresponding author on reasonable request.

The Cardiovascular Health Integrated Lifestyle Diet (CHILD) Lowers LDL-Cholesterol Levels in Brazilian Dyslipidemic Pediatric Patients.

OBJECTIVE: To analyze the impact of the CHILD-2 diet on the lipid profile of Brazilian children and adolescents with dyslipidemia. METHODS: This is a quasi-experimental study, where 149 participants (5-17 years) with mild-to-moderate hypercholesterolemia were divided into two groups (GI: low or normal weight; n = 58 and GII: overweight; n = 91). Both groups underwent the CHILD-2 diet, characterized by 25-30% total fat and less than 7% of low-saturated fat (SF) for 6 months. Changes from baseline in the lipid profile, including Total cholesterol (TC), LDL-C, triacylglycerols and glucose concentrations, dietary and anthropometric data were examined at 3 and 6 months. Longitudinal analyses were performed using linear mixed-effects models in SAS. RESULTS: Serum LDL-C concentrations reduced over time compared with baseline (Δ = -5.1 mg/dL; p < 0.01), with no difference between groups (p = 0.35). TC concentrations decreased by -2.0 mg/dL (p < 0.01); but no difference was observed between groups. We found no significant changes in body mass index/age Z scores after a dietary intervention compared with baseline in both groups (p = 0.94). CONCLUSION: Despite the modest reduction, our findings confirm that children with dyslipidemia can benefit from the CHILD-2 diet combined with a healthy lifestyle.

[Sexual dysfunction among oncological patients: The importance of a specialized approach]. / Disfunção sexual nos doentes oncológicos: a importância de uma abordagem especializada.

OBJECTIVES: Determination of the emotional and sexual impact after oncologic disease and patient's satisfaction regarding information provided by healthcare professionals. We also aim to evaluate the importance of sexology care during cancer treatment and follow-up. METHODS: This is a cross-sectional study including patients admitted for radiation therapy. A questionnaire and an assessment of clinical data were assessed. RESULTS: The study sample was composed by 104 patients. 60.6% had a negative impact on their sexual life after treatment and 62.5% were satisfied about the information given by healthcare professionals. About two thirds of the patients would accept sexology care during cancer treatment and/or follow-up. After a sub-group analysis, there were no statistically significant differences between groups regarding the prevalence of sexual dysfunction or needs for sexual care. DISCUSSION: There is a well-known impact of cancer on sexuality since its diagnosis. Our patients feel themselves well informed about this by health professionals. Most of them would accept being referred to an oncosexology appointment. CONCLUSIONS: Sexuality must be discussed with cancer patients since their diagnosis. Oncosexuality care is necessary and desired by most patients as a mean for reduction of the cancer impact in their life quality.

Activation of PI3K is indispensable for interleukin 7-mediated viability, proliferation, glucose use, and growth of T cell acute lymphoblastic leukemia cells.

Interleukin (IL)-7 is essential for normal T cell development. Previously, we have shown that IL-7 increases viability and proliferation of T cell acute lymphoblastic leukemia (T-ALL) cells by up-regulating Bcl-2 and down-regulating the cyclin-dependent kinase inhibitor p27kip1. Here, we examined the signaling pathways via which IL-7 mediates these effects. We investigated mitogen-activated protein kinase (MEK)-extracellular signal-regulated kinase (Erk) and phosphatidylinositol-3-kinase (PI3K)-Akt (protein kinase B) pathways, which have active roles in T cell expansion and have been implicated in tumorigenesis. IL-7 induced activation of the MEK-Erk pathway in T-ALL cells; however, inhibition of the MEK-Erk pathway by the use of the cell-permeable inhibitor PD98059, did not affect IL-7-mediated viability or cell cycle progression of leukemic cells. IL-7 induced PI3K-dependent phosphorylation of Akt and its downstream targets GSK-3, FOXO1, and FOXO3a. PI3K activation was mandatory for IL-7-mediated Bcl-2 up-regulation, p27kip1 down-regulation, Rb hyperphosphorylation, and consequent viability and cell cycle progression of T-ALL cells. PI3K signaling was also required for cell size increase, up-regulation of CD71, expression of the glucose transporter Glut1, uptake of glucose, and maintenance of mitochondrial integrity. Our results implicate PI3K as a major effector of IL-7-induced viability, metabolic activation, growth and proliferation of T-ALL cells, and suggest that PI3K and its downstream effectors may represent molecular targets for therapeutic intervention in T-ALL.

Treatment of Childhood Obesity Based on Brazilian Dietary Guidelines Plus Energy Restriction (PAPPAS HUPE Study): Protocol for a Randomized Clinical Trial.

BACKGROUND: The Food Guide for the Brazilian Population relies on natural or minimally processed foods mainly of plant origin such as beans and rice with low oil, salt, and sugar content and limited consumption of ultraprocessed foods. Reduction of ultraprocessed foods improves diet quality and energy consumption. OBJECTIVE: The goal of this study is to evaluate the effectiveness of an intervention for the treatment of obesity in children, with counseling based on the Brazilian Food Guide plus control of total energy intake. METHODS: A parallel, randomized clinical trial will include children aged 7 to 12 years. Randomization will be performed in blocks of 10 individuals using computer-generated random sequence numbers. Both the control and intervention groups will participate in 6 standardized educational activities based on the 10 steps of the Brazilian Food Guide. These activities will be conducted at the University Hospital Toy Library, located in the pediatric outpatient clinic. For the intervention group, in addition to the educational activities, an individualized food plan based on the nutritional recommendations of the Brazilian Society of Pediatrics will be prescribed and discussed with the mothers and fathers. The primary outcome of the study will be variations in body mass index, and secondary outcomes will include analysis of insulin resistance, blood pressure, body fat percentage, and waist and neck circumference. RESULTS: This project was funded by the National Council for Scientific and Technological Development in December 2017 (grant no 408333/2017-0). Recruitment began in August 2018 and by September 2019, we had enrolled the 101 participants. In addition to the patients referred by the national system of regulation, recruitment was made by medical outpatient referral and external indication. This is an ongoing study. We expect the results to be published in November 2020. CONCLUSIONS: At the end of the project, in case of a positive result, a protocol for the treatment of obesity based on the Brazilian Food Guide will be proposed to the Unified Health System. A successful method to reduce childhood obesity is expected. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials RBR-3st5sn; http://www.ensaiosclinicos.gov.br/rg/RBR-3st5sn. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/16170.

Income and education level trajectories and changes in the daily consumption of vegetables after thirteen years of follow-up: the Pró-Saúde Study / Trajetórias de renda e nível de educação e mudanças no consumo diário de vegetais após treze anos de acompanhamento: Estudo Pró-Saúde

ABSTRACT Objective: This study aimed to examine whether education level and income trajectories influence vegetable consumption changes over 13 years among civil servants at different campuses of a university in the state of Rio de Janeiro, Brazil. Methods: Vegetable intake frequency (daily and non-daily consumption), income (per capita), and education level (maintenance of low schooling/ upward mobility/maintenance of high schooling) were assessed at baseline (1999) and in the fourth wave (2011-12) of the Pró-Saúde (Pro-Health) cohort study. A total of 2,381 participants were analyzed. The association between educational and income trajectories and variation in vegetable consumption was assessed via crude and age-adjusted generalized linear models, stratified by sex. Results: Men in upward educational mobility showed a 0.5% increase in vegetable consumption (p=0.01), while women in this group demonstrated a 2.5% increase (p=0.05). Adjusted models showed that women who reduced their income had a lower likelihood of consuming vegetables (odds ratio [OR] 0.93; 95% confidence interval [CI] 0.89-0.97). Conclusions: The findings highlight the influence of social inequalities on vegetable consumption in adults.

RESUMO Objetivo: O objetivo deste estudo foi avaliar se as trajetórias do nível de educação e de renda influenciam na mudança do consumo de vegetais ao longo de 13 anos entre funcionários públicos de diferentes campi de uma universidade do Rio de Janeiro, Brasil. Métodos: A frequência de consumo de vegetais (consumo diário e não diário), a renda (per capita) e o nível de educação (manutenção da baixa escolaridade/mobilidade ascendente/ manutenção da alta escolaridade) foram avaliados no início (1999) e na quarta onda (2011-12) do estudo de coorte Pró-Saúde. Foram analisados 2.381 participantes, e a associação entre as trajetórias de escolaridade e renda e a variação no consumo de vegetais foi avaliada via modelos lineares generalizados brutos e ajustados por idade e variação da escolaridade e estratificados por sexo. Resultados: Homens em mobilidade educacional ascendente apresentaram aumento de 0,5% no consumo de vegetais (p=0,01), enquanto mulheres nesse grupo demonstraram aumento de 2,5% (p=0,05). Modelos ajustados mostraram que mulheres que reduziram sua renda apresentaram menor probabilidade de consumir vegetais (odds ratio [OR] 0,93; intervalo de confiança [IC] 95% 0,89-0,97). Conclusão: Os achados destacam a influência das desigualdades sociais no consumo de vegetais em adultos.

[Continuous quadratus lumborum type II block in partial nephrectomy]. / Bloqueio do quadrado lombar tipo II contínuo para analgesia pós­operatória de nefrectomia parcial.

BACKGROUND AND OBJECTIVES: Quadratus lumborum block was first described in 2007 and currently there are descriptions of its achievement through four different injection points. This blockage provides abdominal wall and visceral analgesia, and one of its mechanisms is the dispersion of the local anesthetic into the paravertebral space. We describe the performance of a continuous quadratus lumborum type II block for postoperative analgesia in a partial nephrectomy. CASE REPORT: A 64-year-old woman, scheduled for partial left laparoscopic nephrectomy. During the procedure, due to technical difficulties, an incision was made in the left flank to facilitate the surgical approach. In the early postoperative period, a continuous quadratus lumborum type II block was performed using ultrasonography as part of the multimodal analgesic strategy. Initially, 20ml of 0.2% ropivacaine was administered and 3cm of catheter were introduced into the interfascial space. Subsequently, a continuous infusion of 5.2mL.h-1 of 0.2% ropivacaine was given for 48hours. In the first 24 postoperative hours, the patient reported no pain at rest or on movement. In the following 24hours, she was free of pain at rest and only a slight pain (2/10) on movement. CONCLUSIONS: Continuous quadratus lumborum type II block was an effective postoperative analgesic option. Blocking of somatic nerves and visceral afferent pathways provided abdominal and visceral wall analgesia, allowing the reduction of opioid consumption. We consider relevant to explore the analgesic capacity of the quadratus lumborum block and its different approaches, as well as the possibility of it becoming an alternative in patients scheduled for kidney surgery.

The role of S100a4 (Mts1) in Apc- and Smad4-driven tumour onset and progression.

INTRODUCTION: S100a4 is a calcium-binding protein belonging to the family of S100-proteins, highly expressed in different stromal cell types. S100A4 has been reported as a prognostic marker in colorectal cancer in association with tumour progression and metastasis. METHODS: In this study, we analysed the in vivo role of S100a4 in intestinal tumour initiation and progression using different transgenic and knockout mouse models. RESULTS: We found that genetic ablation or overexpression of S100a4 in both Apc- and Smad4-mutant mice do not affect tumour initiation in the intestinal tract. In contrast, S100a4 epithelial overexpression in Apc1638N/+/KRASV12G mice increases the dissemination of intestinal tumour cells to the liver, in agreement with its role in tumour metastasis. Moreover, we report a novel role for S100a4 in desmoid formation where S100a4 deficiency results in a significant reduction of the tumour burden characteristic of the Apc1638N model. In agreement with these results, S100a4 appears to be co-expressed together with mesenchymal stem cell (MSC) markers in desmoid tumours from Apc1638N/+ mice, as well as from sporadic and hereditary human desmoids. CONCLUSION: Our data provide the first report on the in vivo role of S100a4 in intestinal tumourigenesis and describe a new role for S100a4 in the aetiology of desmoids formation.

[Secondary hypothyroidism after cervical irradiation: systematic evaluation of thyroid function in follow-up]. / Hipotiroidismo secundário à irradiação cervical: avaliação sistemática da função tiroideia no seguimento.

INTRODUCTION: Sometimes Thyroid dysfunction is an underestimated consequence of radiation exposure. The underlying mechanism is not clearly understood, but it is likely to be multifactorial. As so, the specific risk factors associated with the development of secondary radiotherapy hypothyroidism remain undefined. The direct irradiation of the thyroid gland may result more frequently in hypothyroidism. This is an irreversible condition, requiring lifelong treatment and monitoring. OBJECTIVES: To evaluate the incidence of hypothyroidism in patients with head and neck cancer who underwent neck irradiation on an intensive or adjuvant basis and determine whether it is justifiable to integrate the monitoring of parameters for evaluation of thyroid function (TSH, free fraction T3 e free fraction T4 ) in this patient group on the Institutional follow up protocol. MATERIAL AND METHODS: This is an observational, retrospective descriptive study, which comprises a group of 376 patients with head and neck cancer undergoing radiotherapy, on adjuvant or intensive basis, between the years 2007 and 2012, at Portuguese Institute of Oncology of Coimbra, E.P.E. 145 patients met all the inclusion criteria. Standardized rating scales for the definition of hypothyroidism have been used - LENT-SOMA scales (Late Effects Normal Tissues Subjective Objective Management Analysis). Grade 1 or higher was considered as a complication hypothyroidism. RESULTS: The analysis of a cohort of 145 patients was carried out. The most frequent tumor site was the larynx (26.9%). Thirty-two patients received adjuvant radiotherapy and 113 were treated with intensive schemes. The most used radiotherapy technique was intensity modulated (IMRT), performed in 86.2% patients. The overall incidence rate of hypothyroidism at 12 months was 18.6%. The diagnosis for hypothyroidism was done between 9 and 12 months after treatment radiotherapy in 51.9% of the patients with this complication. DISCUSSION: An analysis of the published literature, hypothyroidism is the most common thyroid complication after irradiation and affects a large percentage of patients undergoing cervical radiotherapy with curative intent. It has been shown that the risk of hypothyroidism increases with time after exposure, but the highest incidence appears to be in the first two years after treatment. From our analysis we obtained at 12 months, a rate of incidence of hypothyroidism of 18.6% (16.55% grade 1 and grade 2, 2.1%). CONCLUSIONS: This study found an incidence of hypothyroidism corresponding to the lowest values reported in other published studies. The short duration of follow-up considered in this analysis, may justify these results. With these results and their correlation with the available literature, the authors consider justified and recommend the inclusion of the systematic evaluation of thyroid function in the follow-up protocol of these patients.

Introdução: A disfunção tiroideia constitui uma consequência, por vezes subestimada, da exposição à radiação. O mecanismo subjacente não está claramente esclarecido, mas terá uma origem multifatorial. Os fatores de risco específicos para o desenvolvimento de hipotiroidismo secundário à radioterapia permanecem indeterminados. A irradiação direta da glândula tiroideia pode resultar, com maior frequência, em hipotiroidismo. Este é uma condição irreversível, requerendo monitorização e tratamento permanente. Objetivos: Avaliar a incidência de hipotiroidismo nos doentes portadores de neoplasias da cabeça e pescoço submetidos a irradiação cervical, a título intensivo ou adjuvante, bem como determinar se é justificável a integração no protocolo de seguimento Institucional, de parâmetros laboratoriais (TSH, T3 Livre e T4 Livre) para avaliação da função tiroideia neste grupo de doentes e qual a sua periodicidade. Material e Métodos: Este é um estudo observacional, descritivo, retrospetivo, que engloba um grupo de 376 doentes portadores de neoplasias da cabeça e pescoço, submetidos a tratamento de radioterapia, a título adjuvante ou intensivo, entre os anos de 2007 e 2012, no Instituto Português de Oncologia de Coimbra Francisco Gentil E.P.E. Cumpriram todos os critérios de inclusão 145 doentes. Foram utilizadas escalas de avaliação padronizadas para a definição de hipotiroidismo ­ LENT-SOMA scales (Late Effects Normal Tissues Subjective Objective Management Analysis). Foi considerada como complicação o hipotiroidismo Grau 1 ou superior. Resultados: Procedeu-se à análise de um grupo de 145 doentes. A localização tumoral mais frequente foi a Laringe (26,9%). Trinta e dois doentes efetuaram radioterapia adjuvante e 113 efetuaram esquemas intensivos. A técnica de radioterapia mais utilizada foi a intensidade modulada (IMRT), efetuada em 86,2% doentes. A taxa de incidência global de hipotiroidismo aos 12 meses foi de 18,6%. Em 51,9% dos doentes foi efetuado o diagnóstico de hipotiroidismo entre os 9 e os 12 meses após o tratamento de radioterapia. Discussão: Da análise da literatura publicada, o hipotiroidismo constitui a complicação tiroideia radioinduzida mais frequente e afeta uma grande percentagem de doentes submetidos a radioterapia cervical com intenção curativa. Foi demonstrado que o risco de hipotiroidismo aumenta com o tempo após a exposição, contudo a incidência mais elevada parece ser nos dois primeiros anos após o tratamento. Da nossa análise obtivemos, aos 12 meses uma taxa de incidência global de hipotiroidismo de 18,6%, (grau 1 de 16,55% e grau 2 de 2,1%). Conclusão: Neste estudo foi encontrada uma incidência de hipotiroidismo correspondente aos valores mais baixos descritos em outros estudos publicados. O curto tempo de follow-up considerado nesta análise poderá justificar os resultados obtidos. Face aos resultados obtidos, e correlacionando-os com a literatura disponível, os autores consideram justificável e recomendável a inserção da avaliação sistemática da função tiroideia no protocolo de follow-up destes doentes.

Continuous quadratus lumborum type II block in partial nephrectomy / Bloqueio do quadrado lombar tipo II contínuo para analgesia pós-operatória de nefrectomia parcial

Abstract Background and objectives: Quadratus lumborum block was first described in 2007 and currently there are descriptions of its achievement through four different injection points. This blockage provides abdominal wall and visceral analgesia, and one of its mechanisms is the dispersion of the local anesthetic into the paravertebral space. We describe the performance of a continuous quadratus lumborum type II block for postoperative analgesia in a partial nephrectomy. Case report: A 64-year-old woman, scheduled for partial left laparoscopic nephrectomy. During the procedure, due to technical difficulties, an incision was made in the left flank to facilitate the surgical approach. In the early postoperative period, a continuous quadratus lumborum type II block was performed using ultrasonography as part of the multimodal analgesic strategy. Initially, 20 ml of 0.2% ropivacaine was administered and 3 cm of catheter were introduced into the interfascial space. Subsequently, a continuous infusion of 5.2 mL.h−1 of 0.2% ropivacaine was given for 48 hours. In the first 24 postoperative hours, the patient reported no pain at rest or on movement. In the following 24 h, she was free of pain at rest and only a slight pain (2/10) on movement. Conclusions: Continuous quadratus lumborum type II block was an effective postoperative analgesic option. Blocking of somatic nerves and visceral afferent pathways provided abdominal and visceral wall analgesia, allowing the reduction of opioid consumption. We consider relevant to explore the analgesic capacity of the quadratus lumborum block and its different approaches, as well as the possibility of it becoming an alternative in patients scheduled for kidney surgery.

Resumo Justificativa e objetivos: O bloqueio do quadrado lombar foi descrito pela primeira vez em 2007 e atualmente existem descrições da sua realização através de quatro pontos de injeção. Esse bloqueio promove analgesia da parede abdominal e analgesia visceral e um de seus mecanismos é a dispersão do anestésico local para o espaço paravertebral. Descrevemos a realização do bloqueio do quadrado lombar tipo II contínuo para analgesia pós-operatória numa nefrectomia parcial. Relato de caso: Mulher de 64 anos, agendada para nefrectomia parcial à esquerda por via laparoscópica. Durante o procedimento, por dificuldades técnicas, foi feita uma incisão no flanco esquerdo para facilitar a abordagem cirúrgica. No pós-operatório imediato, fez-se o bloqueio do quadrado lombar tipo II contínuo, recorrendo-se a ultrassonografia, como parte da estratégia analgésica multimodal. Inicialmente foram administrados 20 ml de ropivacaína 0,2% e introduzidos 3 cm de cateter no espaço interfascial. Posteriormente, colocou-se uma perfusão contínua de 5,2 mL.h−1 de ropivacaína 0,2% durante 48 horas. Nas primeiras 24 horas de pós-operatório, a paciente não referiu dor em repouso ou com movimento. Nas 24 horas seguintes, manteve-se sem dor em repouso e apenas com dor ligeira (2/10) com o movimento. Conclusões: A realização do bloqueio quadrado lombar tipo II contínuo foi uma opção analgésica pós-operatória eficaz. O bloqueio de nervos somáticos e das vias aferentes viscerais promoveu analgesia da parede abdominal e visceral, permitiu reduzir o consumo de opioides. Consideramos relevante explorar a capacidade analgésica do bloqueio do quadrado lombar e suas diferentes abordagens, bem como a possibilidade de se tornar uma opção em doentes propostos para cirurgia renal.

Efetividade de uma estratégia para tratamento da obesidade infantil baseada no Guia Alimentar para a População Brasileira: um ensaio randomizado / Effectiveness of a strategy for the treatment of childhood obesity based on the Food Guide for the Brazilian Population: a randomized trial

O Guia Alimentar para a População Brasileira (GAPB) baseia suas recomendações na extensão e propósito do processamento ocorrido nos alimentos, e sugere que a redução do consumo de alimentos ultraprocessados (AUP) está relacionada a melhora na qualidade da alimentação e consequentemente perda de peso. Apesar de alguns estudos terem observado impacto importante na qualidade da dieta, não há evidências que a redução no consumo de AUP seja acompanhada por redução no consumo de energia total. O objetivo deste estudo é avaliar a efetividade de uma proposta de intervenção para tratamento da obesidade em crianças baseada no GAPB. Foi realizado um ensaio clínico randomizado com crianças entre 7 e 12 anos, encaminhados pelo Sistema Nacional de Regulação (SISREG) para atendimento ao ambulatório de nutrição do Hospital Universitário Pedro Ernesto (HUPE). Os participantes do Grupo controle (GC) e do Grupo Intervenção (GI) participaram de 6 atividades educativas padronizadas e contextualizadas com os 10 passos do GAPB. No GI, também foi prescrito um plano alimentar individualizado, com base nas recomendações nutricionais. Análise de intenção de tratar foi realizada para avaliar a taxa de variação do desfecho primário (índice de massa corporal (IMC)) e secundários (circunferência da cintura (CC) e peso), entre os GI e GC, com base em modelos de efeito mistos. Estas análises também foram aplicadas para medir o consumo alimentar, avaliado pela taxa de variação de gramas de AUP. Adicionalmente, os resultados do IMC foram comparados com curvas de crescimento, desenvolvidas pelo método LMS, que representa a evolução do IMC da população do estudo sem intervenção. Dos 101 participantes, 51 foram alocados no GI. Ao final do estudo, o IMC declinou no GI (Δ = -0,27 kg/m2) em relação ao GC (Δ = + 0,53 kg/m2), com diferença estatisticamente significativa entre os grupos (p=0.0002). Ao comparar o GC com a curva LMS, observou-se maior aumento do IMC no grupo LMS (Δ = + 1,02 kg/m2; p<0,0001). Para mudança de peso, o aumento foi maior no GC (Δ= +5,51), comparado ao GI (Δ= +3,7, p=<0,0001). E não houve diferença significativa na trajetória da CC entre os grupos. Ambos os grupos apresentaram um declínio no consumo de gramas de AUP até o quarto mês e um aumento gradual nos meses seguintes, sem diferença estatisticamente significativa (p=0,77). A combinação de uma abordagem qualitativa baseada nas recomendações do guia com o aconselhamento da restrição energética por meio do plano alimentar mostrou-se eficaz na redução da obesidade infantil. As atividades educativas tiveram impacto no consumo de AUP, porém, há uma dificuldade em manter em longos períodos mudanças comportamentais. Uma vez que o consumo destes alimentos pode prejudicar o tratamento da obesidade infantil, são necessárias estratégias que proporcionem a redução do consumo de AUP ao longo do tempo.

The Dietary Guidelines for the Brazilian Population (DGBP) rely its recommendation on the of extent and purpose that occurred in food and suggests that the reducing the consumption of ultra-processed foods (UPF) improves diet quality and consequent weight loss. Although some studies have observed an important impact on the quality of the diet, there is no evidence that the reduction in the consumption of UPF is accompanied by a reduction in total energy consumption. Thus, the goal of this study is to evaluate the effectiveness of an intervention proposal for the treatment of obesity in children based on the DGBP. A randomized clinical trial was carried out with children between 7 and 12 years old, referred by the National Regulatory System (SISREG) to the nutrition outpatient clinic of University Hospital Pedro Ernesto (HUPE) are evaluated. Participants in the Control Group (CG) and Intervention Group (IG) participated in 6 standardized educational activities contextualized with the 10 Steps of DGBP. In the IG, an individualized food plan was prescribed, based on nutritional recommendations. Intent-to-treat analysis were performed to assess the rate of change of primary (body mass index (BMI)) and secondary (waist circumference (WC) and weight) outcomes between IG and CG, based on mixed-effects models. These analyzes were also applied to measure food consumption, assessed by the rate of change of grams of AUP. Additionally, the BMI results were compared with growth curves, developed by the LMS method, which represents the BMI evolution of the study population without intervention. Of the 101 participants, 51 were allocated to the IG. At the end of the study, BMI declined in the IG (Δ = -0.27 kg/m2) in relation to the CG (Δ = + 0.53 kg/m2), with a statistically significant difference between the groups (p=0.0002). When comparing the GC with the LMS curve, a greater increase in BMI was observed in the LMS group (Δ = + 1.02 kg/m2; p<0.0001). For weight change, the increase was greater in the CG (Δ= +5.51), compared to the IG (Δ= +3.7, p=<0.0001). And there was no significant difference in the trajectory of WC between groups. Both groups showed a decline in grams of UPF until the fourth month and a gradual increase in the following months, with no statistically significant difference (p=0.77). The combination of a qualitative approach based on the DGBP with energy restriction advice through the food plan proved to be effective in reducing childhood obesity. Educational activities had an impact on UPF consumption, however, there is a difficulty in maintaining behavioral changes over long periods. Since the consumption of these foods can impair the treatment of childhood obesity, strategies are needed to reduce UPF consumption over time.

Disfunção sexual nos doentes oncológicos: a importância de uma abordagem especializada / Sexual dysfunction among oncological patients: The importance of a specialized approach

OBJETIVOS: Determinação do impacto oncológico a nível afetivo/sexual assim como do grau de satisfação dos doentes quanto à informação recebida. Pretende‐se, adicionalmente, avaliar a importância da existência de uma abordagem especializada em sexologia durante o tratamento e seguimento oncológico. MÉTODOS: Estudo transversal que incluiu doentes oncológicos admitidos para consulta num serviço de radioterapia. Aplicação de um questionário e aferição de dados clínicos através do processo clínico. RESULTADOS: Amostra de 104 doentes, com uma média de 64,7 anos, em que a maioria (60,6%) refere ter disfunção sexual após o tratamento oncológico. Relativamente ao grau de informação, 62,5% encontram‐se satisfeitos quanto à informação fornecida pelos profissionais de saúde. Cerca de 2/3 dos doentes (66,4%) recorreriam a uma consulta de oncossexologia caso fossem referenciados pelo médico assistente. Não foram observadas diferenças estatisticamente significativas entre os subgrupos analisados relativamente ao impacto oncológico na sexualidade nem quanto à necessidade de uma abordagem especializada em sexologia. DISCUSSÃO: A abordagem da sexualidade nos doentes oncológicos engloba tanto o esclarecimento dos doentes como o tratamento das disfunções sexuais inerentes aos tratamentos. A existência de consultas de oncosexologia é uma forma de abordagem especializada, é do interesse da maioria dos nossos doentes. CONCLUSÕES: A sexualidade deve ser abordada com o doente oncológico desde o início da doença. Os cuidados especializados de oncossexologia são importantes ao constituírem uma via de redução do impacto oncológico na qualidade de vida

OBJECTIVES: Determination of the emotional and sexual impact after oncologic disease and patient's satisfaction regarding information provided by healthcare professionals. We also aim to evaluate the importance of sexology care during cancer treatment and follow‐up. METHODS: This is a cross‐sectional study including patients admitted for radiation therapy. A questionnaire and an assessment of clinical data were assessed. RESULTS: The study sample was composed by 104 patients. 60.6% had a negative impact on their sexual life after treatment and 62.5% were satisfied about the information given by healthcare professionals. About two thirds of the patients would accept sexology care during cancer treatment and/or follow‐up. After a sub‐group analysis, there were no statistically significant differences between groups regarding the prevalence of sexual dysfunction or needs for sexual care. DISCUSSION: There is a well‐known impact of cancer on sexuality since its diagnosis. Our patients feel themselves well informed about this by health professionals. Most of them would accept being referred to an oncosexology appointment. CONCLUSIONS: Sexuality must be discussed with cancer patients since their diagnosis. Oncosexuality care is necessary and desired by most patients as a mean for reduction of the cancer impact in their life quality

Associação do consumo de fibras e risco cardiovascular em pacientes idosos / Association of fiber intake and cardiovascular risk in elderly patients

Fundamentos: A doença cardiovascular está na liderança de causas de mortalidade. Através da alimentaçãopodem ser modificados alguns fatores de risco e a fibra dietética exerce papel importante na prevenção dessasdoenças.Objetivo: Avaliar o consumo de fibras, os fatores de risco cardiovascular e a associação entre eles em pacientesidosos atendidos em ambulatório de nutrição.Métodos: Estudo descritivo, retrospectivo, realizado mediante análise do recordatório de 24 horas e levantamentodos fatores de risco cardiovascular: circunferência abdominal, dados de lipidograma e glicemia de jejum, sedentarismoe tabagismo. Os participantes foram estratificados em grupos segundo o índice de massa corporal (IMC).Resultados: Foram avaliados 40 prontuários e encontrada maior prevalência em pacientes com sobrepeso (45,0%)e obesos (27,5%). Além disso, 72,5% relataram ser sedentários e 82,5% não tabagistas. As maiores médias de colesteroltotal, triglicerídeos e LDL-colesterol foram observadas nos eutróficos: 194,5±48,5 mg/dL; 167,2±95,9 mg/dL e130,0±37,7 mg/dL, respectivamente. Os obesos apresentaram menor média de HDL-colesterol (44,0±8,9 mg/dL)enquanto a maior média de glicemia de jejum (109,8±29,1 mg/dL) foi encontrada no grupo de sobrepeso. Oconsumo de fibras totais (g/dia) foi: 25,1±6,6 nos desnutridos; 22,6±7,0 nos eutróficos; 23,3±6,0 no grupo desobrepeso e 22,0±3,4 nos obesos. Não houve associação significativa com nenhuma das variáveis analisadas.Conclusão: Não foi encontrada associação entre o consumo de fibras e os fatores de risco cardiovascular analisadosem idosos deste estudo.

Background: Cardiovascular disease is the leading cause of mortality. Through food, some risk factors may be modified and dietaryfiber plays an important role in preventing these diseases.Objective: To assess fiber intake, cardiovascular risk factors and the association between them in elderly patients at a nutrition clinic.Methods: Descriptive retrospective study conducted by analyzing 24-hour dietary recall and survey of cardiovascular risk factors:waist circumference, lipid profile data and fasting glucose, physical inactivity and smoking. The participants were stratified intogroups according to body mass index (BMI).Results: Forty records were evaluated and higher prevalence was found in overweight patients (45.0%) and obese patients (27.5%).In addition, 72.5% reported being physically inactive and 82.5% are non-smokers. The highest averages of total cholesterol, triglyceridesand LDL cholesterol were observed in eutrophic patients: 194.5±48.5 mg/dL; 167.2±95.9 mg/dL and 130.0±37.7 mg/dL,respectively. Obese patients had lower average HDL-cholesterol levels (44.0±8.9 mg/dL) while the highest average fasting glucose(109.8±29.1 mg/dL) was observed in the overweight group. The total fiber intake (g/day) was: 25.1±6.6 in malnourished patients;22.6±7.0 in eutrophic patients; 23.3±6.0 in the overweight group and 22.0±3.4 in obese patients. There was no significant associationwith any of the variables analyzed.Conclusion: No association was found between fiber consumption and the cardiovascular risk factors analyzed in the elderlyindividuals of this study.

CD40-targeted adenoviral gene transfer to dendritic cells through the use of a novel bispecific single-chain Fv antibody enhances cytotoxic T cell activation.

Adenoviral (Ad) transduction of dendritic cells (DC) is a promising vaccination strategy. However, clinical applicability of Ad vectors is hampered by the necessity to use high titers of infectious Ad particles for efficient DC transduction. Here, we report on the production of a bacterially expressed bispecific conjugate, consisting of a fusion of recombinant single-chain (sc) mAb Fv fragments, which bind and neutralize the Ad fiber knob (through the S11 mAb scFv) and retarget Ad to CD40 on the DC surface (through the G28-5 mAb scFv). We show that this bispecific scFv fusion protein significantly enhances transduction efficiency of monocyte-derived DC (MoDC), reduces the amount of virus needed for a given level of transduction, and increases the ability of MoDC to activate CTL in an antigen specific manner. This single-component conjugate may prove to be a valuable immunotherapeutic tool for the targeting of Ad to DC in vivo.