Brazilian guide to nutrition in bariatric and metabolic surgery.

PURPOSE: Brazilian nutrition recommendations for bariatric and metabolic surgery aim to provide knowledge, based on scientific evidence, on nutritional practices related to different surgical techniques in the surgical treatment of obesity and metabolic diseases. MATERIALS AND METHODS: A systematic literature search was carried out with the appropriate MeSH terms using Medline/Pubmed/LiLACS and the Cochrane database, with the established criteria being based on the inclusion of articles according to the degree of recommendation and strength of evidence of the Classification of Recommendations, Evaluation, Development, and Evaluation System (GRADE). RESULTS: The recommendations that make up this guide were gathered to assist in the individualized clinical practice of nutritionists in the nutritional management of patients with obesity, including nutritional management in the intragastric balloon; pre and postoperative nutritional treatment and supplementation in bariatric and metabolic surgeries (adolescents, adults, elderly, pregnant women, and vegetarians); hypoglycemia and reactive hyperinsulinemia; and recurrence of obesity, gut microbiota, and inflammatory bowel diseases. CONCLUSION: We believe that this guide of recommendations will play a decisive role in the clinical practice of nutritionists who work in bariatric and metabolic surgery, with its implementation in health services, thus promoting quality and safety in the treatment of patients with obesity. The concept of precision nutrition is expected to change the way we understand and treat these patients.

Fertilized graminoids intensify negative drought effects on grassland productivity.

Droughts can strongly affect grassland productivity and biodiversity, but responses differ widely. Nutrient availability may be a critical factor explaining this variation, but is often ignored in analyses of drought responses. Here, we used a standardized nutrient addition experiment covering 10 European grasslands to test if full-factorial nitrogen, phosphorus, and potassium addition affected plant community responses to inter-annual variation in drought stress and to the extreme summer drought of 2018 in Europe. We found that nutrient addition amplified detrimental drought effects on community aboveground biomass production. Drought effects also differed between functional groups, with a negative effect on graminoid but not forb biomass production. Our results imply that eutrophication in grasslands, which promotes dominance of drought-sensitive graminoids over forbs, amplifies detrimental drought effects. In terms of climate change adaptation, agricultural management would benefit from taking into account differential drought impacts on fertilized versus unfertilized grasslands, which differ in ecosystem services they provide to society.

Unravelling associations between tree-seedling performance, herbivory, competition, and facilitation in high nature value farmlands.

Herbivory, plant facilitation, and competition have complex impacts on tree regeneration which are seldom investigated together. Grazing exclosure experiments have allowed quantification of the effects of large herbivores on tree regeneration dynamics but have often ignored the effect of herbivorous insects. We experimentally tested how folivory (percentage of leaf damaged by insects) and microenvironment (tree canopy cover and herbs) jointly alter performance (growth and survival) of seedlings of two dominant Mediterranean oak-species within ungulate exclosures in a 3-year field study. An agroforestry system dominated by cork oak (Quercus suber) and holm oak (Q. rotundifolia) was assessed in south-east Portugal. We aimed also to determine whether the two oak species differed in the interdependences between folivory, microenvironment, covaring factors, and seedling performance. Unexpectedly, under the low-moderate insect defoliation, growth and survival of cork and holm oak seedlings were positively associated with herbivore damage. Herb removal increased oak folivory by 1.4 times. Herb removal was also positively associated with growth, directly and indirectly through its negative effect on oak folivory. Tree canopy favored insect folivory upon cork oak seedlings directly and upon holm oak indirectly via decreasing light availability. Folivory was threefold greater upon cork than upon holm oak-seedlings. Our study shows that tree canopy, herbs, and covarying factors can affect cork and holm oak-seedling performances through complex pathways, which markedly differ for the two species. The combined effect of insect herbivory and positive and negative plant-plant interactions need to be integrated into future tree regeneration efforts toward tackling the regeneration crisis of oak agroforestry systems of the Mediterranean.

Use of Next-Generation Sequencing to Support the Diagnosis of Familial Interstitial Pneumonia.

Familial interstitial pneumonia (FIP) is defined as idiopathic interstitial lung disease (ILD) in two or more relatives. Genetic studies on familial ILD discovered variants in several genes or associations with genetic polymorphisms. The aim of this study was to describe the clinical features of patients with suspected FIP and to analyze the genetic variants detected through next-generation sequencing (NGS) genetic testing. A retrospective analysis was conducted in patients followed in an ILD outpatient clinic who had ILD and a family history of ILD in at least one first- or second-degree relative and who underwent NGS between 2017 and 2021. Only patients with at least one genetic variant were included. Genetic testing was performed on 20 patients; of these, 13 patients had a variant in at least one gene with a known association with familial ILD. Variants in genes implicated in telomere and surfactant homeostasis and MUC5B variants were detected. Most variants were classified with uncertain clinical significance. Probable usual interstitial pneumonia radiological and histological patterns were the most frequently identified. The most prevalent phenotype was idiopathic pulmonary fibrosis. Pulmonologists should be aware of familial forms of ILD and genetic diagnosis.

Establishment of a transparent soil system to study Bacillus subtilis chemical ecology.

Bacterial secondary metabolites are structurally diverse molecules that drive microbial interaction by altering growth, cell differentiation, and signaling. Bacillus subtilis, a Gram-positive soil-dwelling bacterium, produces a wealth of secondary metabolites, among them, lipopeptides have been vastly studied by their antimicrobial, antitumor, and surfactant activities. However, the natural functions of secondary metabolites in the lifestyles of the producing organism remain less explored under natural conditions, i.e. in soil. Here, we describe a hydrogel-based transparent soil system to investigate B. subtilis chemical ecology under controllable soil-like conditions. The transparent soil matrix allows the growth of B. subtilis and other isolates gnotobiotically and under nutrient-controlled conditions. Additionally, we show that transparent soil allows the detection of lipopeptides production and dynamics by HPLC-MS, and MALDI-MS imaging, along with fluorescence imaging of 3-dimensional bacterial assemblages. We anticipate that this affordable and highly controllable system will promote bacterial chemical ecology research and help to elucidate microbial interactions driven by secondary metabolites.

Herbivory and nutrients shape grassland soil seed banks.

Anthropogenic nutrient enrichment and shifts in herbivory can lead to dramatic changes in the composition and diversity of aboveground plant communities. In turn, this can alter seed banks in the soil, which are cryptic reservoirs of plant diversity. Here, we use data from seven Nutrient Network grassland sites on four continents, encompassing a range of climatic and environmental conditions, to test the joint effects of fertilization and aboveground mammalian herbivory on seed banks and on the similarity between aboveground plant communities and seed banks. We find that fertilization decreases plant species richness and diversity in seed banks, and homogenizes composition between aboveground and seed bank communities. Fertilization increases seed bank abundance especially in the presence of herbivores, while this effect is smaller in the absence of herbivores. Our findings highlight that nutrient enrichment can weaken a diversity maintaining mechanism in grasslands, and that herbivory needs to be considered when assessing nutrient enrichment effects on seed bank abundance.

Commercial bee pollen with different geographical origins: a comprehensive approach.

Since the primordial of humanity, pollen has been considered a good source of nutrients and energy. Its promising healing properties have also been referred to. The present study aimed to characterize, for the first time, eight commercial pollens from Portugal and Spain available on the market studying the legislation on labeling, pollinic origin, physicochemical and microbiological analyses and identification of yeasts. Eleven botanical families were found amongst the samples. The most abundant family and the most dominant pollen was Cistaceae. The moisture content, ash, a(w), pH, reducing sugars, carbohydrates, proteins, lipids and energy were analyzed and the specific parameters were within the specifications required by some countries with legislation regarding these parameters. Microbiologically commercial pollen showed acceptable safety for the commercial quality and hygiene. All samples showed negative results for toxigenic species. The microorganisms studied were aerobic mesophiles, yeasts and moulds, coliforms, Escherichia coli, Staphylococcus aureus, Salmonella and sulfite-reducing Clostridium. During the work, six yeasts species were isolated from pollen, with Rhodotorula mucilaginosa being the most abundant, as it was present in four samples.

Transition from APAP to CPAP may be a cost-effective health intervention in OSA patients.

OBJECTIVE: Obstructive sleep apnea (OSA) is a common disorder associated with a significant economic burden. Continuous positive airway pressure (CPAP) and auto-titrating positive airway pressure (APAP) are recognized therapeutic options in patients with OSA, although treatment costs are higher with APAP. We conducted a study aimed at evaluating the effectiveness and potential cost savings resulting from the implementation of a protocol guiding the transition to CPAP in OSA patients previously treated with APAP. METHODS: This prospective study included patients with OSA under APAP who were followed up at the Sleep Medicine outpatient clinic of a tertiary referral hospital between January 2019 and January 2021. Treatment was switched to CPAP in patients who met the following criteria: satisfactory adaptation and adherence to APAP, residual apnea-hypopnea index (AHI) of < 5/hour, and no relevant air leaks. APAP and CPAP outcomes were compared and an estimate of the savings obtained by the transition from APAP to CPAP was calculated. RESULTS: Ninety-three patients were included in the study. APAP and CPAP were both effective in correcting obstructive events and improving daytime sleepiness. No significant differences were found regarding treatment adherence and tolerance between both PAP modalities. The selection of fixed-pressure CPAP through 90th or 95th percentile APAP pressure proved to be effective and an alternative strategy to titration polysomnography. At the end of this two-year study, the transition from APAP to CPAP enabled savings of at least 10,353€. CONCLUSION: The transition from APAP to CPAP may be an effective, well-tolerated, safe, and cost-saving strategy in patients with OSA.

Assessment of microbiota present on a Portuguese historical stone convent using high-throughput sequencing approaches.

The study performed on the stone materials from the Convent of Christ revealed the presence of a complex microbial ecosystem, emphasizing the determinant role of microorganisms on the biodecay of this built cultural heritage. In this case study, the presence of Rubrobacter sp., Arthrobacter sp., Roseomonas sp., and Marinobacter sp. seems to be responsible for colored stains and biofilm formation while Ulocladium sp., Cladosporium sp., and Dirina sp. may be related to structural damages. The implementation of high-throughput sequencing approaches on the Convent of Christ's biodecay assessment allowed us to explore, compare, and characterize the microbial communities, overcoming the limitations of culture-dependent techniques, which only identify the cultivable population. The application of these different tools and insights gave us a panoramic view of the microbiota thriving on the Convent of Christ and signalize the main biodeteriogenic agents acting on the biodecay of stone materials. This finding highlighted the importance of performing metagenomic studies due to the improvements and the reduced amount of sample DNA needed, promoting a deeper and more detailed knowledge of the microbiota present on these dynamic repositories that support microbial life. This will further enable us to perform prospective studies in quarry and applied stone context, monitoring biogenic and nonbiogenic agents, and also to define long-term mitigation strategies to prevent biodegradation/biodeterioration processes.

Author Correction: Leaf nutrients, not specific leaf area, are consistent indicators of elevated nutrient inputs.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

A prolonged dry season and nitrogen deposition interactively affect CO2 fluxes in an annual Mediterranean grassland.

Mediterranean annual grasslands are species-diverse ecosystems of high economic and ecological value. CO2 and water fluxes in these grasslands are triggered by the first rains in autumn, after a long hot and dry summer. Climate change scenarios project altered rainfall patterns, such as prolonged dry season into the autumn, while simultaneously nitrogen (N) deposition is increasing globally. However, how these global change drivers will interact to affect Mediterranean grassland CO2, water fluxes and productivity is still unclear. In a greenhouse experiment, we subjected the seedbank of an annual Mediterranean grassland to a factorial treatment, by prolonging the dry season by 0 days (i.e. no autumn drought), 50 days and 100 days and crossing these drought treatments with two levels of N deposition: no N and N addition. A delayed onset of the rain season, i.e., a prolonged dry season, induced lower CO2 and water fluxes throughout the growing season and a lower aboveground biomass by the end of the study period. However, N addition attenuated the effects on NEE, Reco and GPP, but did not affect aboveground biomass or functional group composition. A prolonged dry season also lowered the productivity of forbs, the dominant functional group in our grassland. Our results anticipate important effects of interacting global change drivers on Mediterranean grassland functioning.

Reduction of Serum Concentrations and Synergy between Retinol, ß-Carotene, and Zinc According to Cancer Staging and Different Treatment Modalities Prior to Radiation Therapy in Women with Breast Cancer.

The procedures used for breast cancer treatment are able to increase the level of oxidative stress and cause depletion of antioxidants. OBJECTIVES: To investigate the relationship between serum concentrations of retinol, ß-carotene, and zinc, according to breast cancer staging, considering different treatment modalities prior to radiation therapy and the synergistic action between these micronutrients. METHODS: This is a cross-sectional observational study comprising a cohort of patients with breast cancer which was carried out prior to radiation therapy. Patients were divided into 3 groups: G1 comprised women who had undergone breast-conserving surgery, G2 comprised those who had undergone chemotherapy, and G3 those who had undergone breast-conserving surgery and chemotherapy. Serum concentrations of retinol, ß-carotene, and zinc were quantified. Breast cancer staging was based on the TNM (Tumor, Node, Metastasis) classification of malignant tumors, a type of staging tool for different cancers. RESULTS: A total of 230 patients were assessed. A decrease of the serum concentrations of the micronutrients assessed as the staging level of the disease increased was observed. Surgery alone had a greater negative impact on serum concentrations of retinol. Considering the treatments prior to radiotherapy, patients undergoing surgery alone and chemotherapy associated with surgery had higher percentages of deficiency of ß-carotene and retinol. There was a positive correlation between the concentrations of zinc, retinol, and ß-carotene, showing a synergy between these micronutrients. CONCLUSION: A significant reduction in the serum concentrations of the assessed micronutrients was observed, according to the increase in breast cancer staging. The synergy between the micronutrients must be considered in order to maximize the benefits and minimize the adverse effects of irradiation to normal cells.

Leaf nutrients, not specific leaf area, are consistent indicators of elevated nutrient inputs.

Leaf traits are frequently measured in ecology to provide a 'common currency' for predicting how anthropogenic pressures impact ecosystem function. Here, we test whether leaf traits consistently respond to experimental treatments across 27 globally distributed grassland sites across 4 continents. We find that specific leaf area (leaf area per unit mass)-a commonly measured morphological trait inferring shifts between plant growth strategies-did not respond to up to four years of soil nutrient additions. Leaf nitrogen, phosphorus and potassium concentrations increased in response to the addition of each respective soil nutrient. We found few significant changes in leaf traits when vertebrate herbivores were excluded in the short-term. Leaf nitrogen and potassium concentrations were positively correlated with species turnover, suggesting that interspecific trait variation was a significant predictor of leaf nitrogen and potassium, but not of leaf phosphorus concentration. Climatic conditions and pretreatment soil nutrient levels also accounted for significant amounts of variation in the leaf traits measured. Overall, we find that leaf morphological traits, such as specific leaf area, are not appropriate indicators of plant response to anthropogenic perturbations in grasslands.

Treatment of advanced non small cell lung cancer with erlotinib. Two clinical cases. / Erlotinib no tratamento do carcinoma pulmonar de não pequenas células, doença avançada. A propósito de dois casos clínicos.

Early studies with tirosine kinase inhibitors (TKI), namely Erlotinib and Gefitinib, in patients with non small cell lung cancer (NSCLC), showed that although most patients did not respond radiologically, a small percentage of those patients (about 10%) had an excellent response to treatment, with radiological regression and clinical response duration. Four patient populations are known as having better response to TKI as opposed to other patients: adenocarcinoma patients, non-smokers, women and asians. Nevertheless, a good general status remains a predictive factor for treatment response. The discovery of the EGFR mutation in NSCLC patients' tumors and its association with clinical response to Erlotinib and Gefitinib, confirmed by a considerable number of retrospective and prospective studies, showed that response rates are between 75-80% in patients carrying this mutation. Although several mutations have been identified, the two commonest (approximately 90%) are located in exons 19 and 21. The authors present two patients studied and treated at the Pulmonology Department's Lung Oncology Unit of CHVNGaia, where Erlotinib was used as 3(rd) line treatment: in one patient, which was part of the population with good response to TKI, a classic exon 19 was identified, and was treated with Erlotinib for twenty months with clinical stability; the other patient did not belong to the above mentioned population and an Exon 20 mutation was identified (a mutation not yet described in literature, being not clear its association with response to treatment with TKI) - treatment was stopped after 7.4months due to disease progression. Rev Port Pneumol 2008; XIV (Supl 3): S43-S51.

Bacterial, yeast, parasitic, and viral enteropathogens in HIV-infected children from São Paulo State, Southeastern Brazil.

We present here the frequency of enteropathogens in an HIV-infected children group and investigate their correlation with clinical and sociodemographic characteristics by collecting 100 stool samples from 55 HIV-seropositive Brazilian children. All specimens were processed according to standard methods for bacterial and yeast detection. A commercially available enzyme-linked immunosorbent assay was used to detect protozoan, and to perform virus detection, molecular tests were applied. Consumption of raw vegetables and fruits and severe immunosuppression were significantly associated with diarrhea. Cryptosporidium parvum was the commonest enteropathogen, followed by Candida albicans, enteropathogenic Escherichia coli, and astrovirus. The number of potential pathogenic agents identified in fecal specimens in asymptomatic HIV-seropositive infants is high, which raises the need for additional investigation in this area as well as in other Brazilian regions.

Tipos de processamento no consumo alimentar de alunos universitários / Types of processing in the food consumption of university students

Objetivo Avaliar universitários através de questionário de frequência alimentar (quantitativo e qualitativo) e classificar a ingestão de alimentos de acordo com o tipo de processamento. Métodos Trata-se de um estudo transversal observacional, em que foi enviado um questionário para os alunos dos cursos de Nutrição, Educação Física, Enfermagem, Administração, Farmácia, Psicologia, Engenharia Civil e Fisioterapia da Instituição de Ensino Superior Universidade Salgado de Oliveira, Rio de Janeiro. Foram coletadas as seguintes informações: curso, sexo e o consumo alimentar nas refeições diárias, separadas por porções: desjejum, colação, almoço, lanche da tarde, jantar e ceia. Em seguida, os alimentos que os estudantes relataram consumir foram separados em quatro categorias: in natura; minimamente processado; processado e ultraprocessado, baseando-se nas nomenclaturas do Guia Alimentar Brasileiro. Resultados Foram coletados dados de 201 alunos, o equivalentes a 5% dos alunos matriculados nos cursos de Nutrição, Educação Física, Enfermagem, Administração, Farmácia, Psicologia, Engenharia Civil e Fisioterapia da Universidade Salgado de Oliveira. Observou-se um alto consumo de alimentos processados na amostra como um todo, porém de forma mais expressiva pelos alunos do curso de Engenharia Civil. Em contrapartida, o maior consumo de alimentos in natura e minimamente processados foi declarado pelos alunos do curso de Educação Física. Conclusão As análises mostraram que o consumo alimentar dos alunos do curso de Educação Física era mais saudável em termos de processamento, possivelmente devido ao cuidado maior desses alunos com a saúde física. Já os alunos do curso de Engenharia Civil consumiam mais alimentos ultraprocessados. O consumo prolongado de alimentos ultraprocessados e processados aumenta o risco de desenvolvimento de doenças crônicas não transmissíveis, levando a um maior risco de mortalidade em longo prazo.

Objective To evaluate university students with a food frequency questionnaire (quantitative and qualitative), and classify the intake according to food processing. Methods This is a cross-sectional observational study, in which a questionnaire was sent to students from the following undergraduate courses: Nutrition, Physical Education, Nursing, Business Management, Pharmacy, Psychology, Civil Engineering and Physiotherapy of the Higher Education Institution at Salgado de Oliveira University, in Rio de Janeiro. The following information was collected: the undergraduate course, gender and food consumption separated by portions in daily meals: breakfast, mid-morning snack, lunch, afternoon snack, dinner and supper. Then, the foods were separated into four categories: fresh; minimally processed; processed; ultra-processed, based on the nomenclatures of the "Brazilian Food's Guide". Results The data were collected from 201 students, equivalent to 5% of the courses in Nutrition, Physical Education, Nursing, Business Management, Pharmacy, Psychology, Civil Engineering and Physiotherapy at Salgado de Oliveira University. It was observed a higher consumption of processed foods in the sample as a whole, however, the highest intake was in the Civil Engineering Course. On the other hand, the highest consumption of fresh and minimally processed foods was found in Physical Education Course students. Conclusion The analyzes showed that food consumption of Physical Education students proved to be healthier in terms of processing, possibly due to the greater care with the physical health of these students, while the students of Civil Engineering course consumed a worrisome diet with more ultra-processed and less fresh foods. The prolonged consumption of ultra-processed and processed foods increases the risk of developing chronic non-communicable diseases, worsening the population's quality of life, leading to a higher risk of long-term mortality.

Oral Rehabilitation and Management for Secondary Sjögren's Syndrome in a Child.

The aim of this paper is to describe a rare case report of a pediatric patient with secondary Sjögren's syndrome (SSS). A 12-year-old female child was referred to the Pediatric Dentistry Clinic with the chief complaint of tooth pain, dry mouth, and tooth sensibility. The patient was submitted to orthodontic treatment prior to syndrome diagnosis. The clinical treatment consisted of the interruption of orthodontic treatment and restoring the oral condition with dental treatment and the use of artificial saliva in an innovative apparatus. Dental therapy involved the control of dental caries, periodontal disease, and opportunistic fungal infections and the use of fluoride-rich solutions. The present clinical case describes clinical and laboratory aspects of SSS in pediatric patients. The management of the oral findings promoted an improvement in the oral health status and quality of life of the child.

Retinol, ß-carotene and oxidative stress in systemic inflammatory response syndrome.

OBJECTIVE: patients suffering systemic inflammatory response syndrome (SIRS) constitute a group susceptible to elevated levels of oxidative stress. This study's aim is to evaluate the state of oxidative stress and levels of serum retinol and ß-carotene in these patients. METHODS: forty-six patients were divided into 2 groups: those those without diet (G1; n=18) and those with enteral nutritional support (G2; n=28). Serum levels of retinol and total carotenoids were measured. C-reactive protein (CRP) levels and Apache scores were also calculated. Oxidative stress was estimated by measuring thiobarbituric acid reactive substance (TBARS) levels. RESULTS: the patients' median age was 66.9 (SD=19.3) years. Lower concentrations of retinol and carotenoids were found in 68.6 and 66.7% of G1, respectively. In G2, despite average vitamin A levels being 8078 + 4035, retinol and ß-carotene were considered insufficient (31.2 and 33.4%, respectively). No difference was noted between the 2 groups, according to the variables studied, with the exception being PCR and ß-carotene (p=0.002; p=0.01). CONCLUSION: the data presented in this study supports the need to establish/revise clinical practices in treating SIRS patients, in light of this micronutrient's role in the immune system and antioxidant defense without it interfering with its toxicity.

The relationship between serum vitamin A and breast cancer staging before and after radiotherapy.

INTRODUCTION: Several adverse effects of radiotherapy have been associated with the process of increased oxidative stress in the organism. In this context, vitamin A noteworthy for its important role in combating oxidative stress, in addition to its chemoprotective effect. OBJECTIVE: To assess the serum levels of vitamin A (retinol and ß-carotene) and their relationship to breast cancer staging in patients before and after radiotherapy. METHODS: This is a prospective study of women with breast cancer who were evaluated from October 2011 to September 2012 before (T0) and after radiotherapy (T1-7 days). Serum retinol and ß-carotene levels were analyzed using High Performance Liquid Chromatography. The assignment of breast cancer stages was based on the classification of malignant tumors that has been proposed by the International Union Against Cancer. RESULTS: 230 patients (mean age 63.6 years, SD ± 9.38) were evaluated. There was a significant reduction in the serum retinol (45.1 ± 18.2 µg/dL at T0 to 27.1 ± 11.7 µg/dL at T1, p < 0.001) and ß-carotene (209.0 ± 153.6 µg/L at T0 to 47.7 ± 25.5 µg/L at T1, p < 0.001). There was also a significant difference in serum retinol (p < 0.001) and ß-carotene (p = 0.003) levels based on the disease stage. CONCLUSIONS: It is recommended the early establishment of adequation serum concentrations of retinol and beta-carotene, offering nutritional assistance for those patients with deficiencies, in order to minimize the harmful effects of radiation.