Compliance with the 24-h movement behaviors guidelines among urban and rural Brazilian preschoolers.

BACKGROUND: The importance of movement behaviors for health is well-known, although few studies have examined the compliance with movement guidelines in preschoolers from different living contexts. This study reported the compliance with the 24-h movement behaviors guidelines among low-income Brazilian preschoolers from rural and urban areas, according to age. METHODS: A total of 453 preschoolers (n = 222 urban), aged between 3 and 5 years, provided physical activity (PA) data (Actigraph wGT3X). Sleep duration, and screen time were parent-reported. Preschoolers were classified as compliant/non- compliant with the 24-h movement guidelines, according to age. The association between prevalence of compliance with the recommendations and the children's living setting were estimated (SPSS; 27.0). RESULTS: Preschoolers were active (mean = 299.19 ± 76.42; and 369.76 ± 95.56 min/day in urban and rural areas, respectively), though moderate-to-vigorous physical activity (MVPA) time was below the 60 daily minutes recommended in both urban and rural settings (mean = 38.39 ± 21.36; and 47.32 ± 24.28, respectively). None of the urban children complied with the three recommendations simultaneously, while in the rural area, only 2.6% were compliant. Single movement behaviors compliances in the urban setting were 6.8%, 28.8% and 5.4% for PA, sleep, and screen time, respectively; while for rural settings were 16.5%, 21.2%, and 7.4%. Living in the rural area was related to the compliance with PA recommendation for the 5-year-old preschoolers. CONCLUSION: In both urban and rural Brazilian areas, very few preschoolers are compliant with the guidelines, and more than one third of the children do not comply with any of the recommendations. Strategies and programs to promote compliance with movement behaviors guidelines should consider children's living setting and their age groups.

Sex differences in 3- to 5-year-old children's motor competence: A pooled cross-sectional analysis of 6241 children.

There is some, albeit inconsistent, evidence supporting sex differences in preschoolers' motor competence (MC), with these observations not uniform when analyzed by age, and cultural groups. Thus, this study examined sex differences across ages in 3- to 5-year-old children's MC. A cross-country pooled sample of 6241 children aged 3-5 years (49.6% girls) was assessed for MC using the Test of Gross Motor Development-2nd/3rd edition, and children were categorized into groups of age in months. Multiple linear regression models and predictive margins were calculated to explore how sex and age in months affect scores of MC (i.e., locomotor and ball skills), with adjustments for country and BMI. The Chow's Test was used to test for the presence of a structural break in the data. Significant differences in favor of girls were seen at 57-59 and 66-68 months of age for locomotor skills; boys performed better in ball skills in all age periods, except for 42-44 and 45-47 months of age. The higher marginal effects were observed for the period between 45-47 and 48-50 months for locomotor skills (F = 30.21; and F = 25.90 for girls and boys, respectively), and ball skills (F = 19.01; and F = 42.11 for girls and boys, respectively). A significantly positive break point was seen at 45-47 months, highlighting the age interval where children's MC drastically improved. The identification of this breakpoint provides an evidence-based metric for when we might expect MC to rapidly increase, and an indicator of early delay when change does not occur at that age.

Performance of Immunohistochemical and Molecular Methods in Detecting Microsatellite Instability in Gastric Cancer: A Multicenter Study.

INTRODUCTION: Microsatellite instability (MSI) is an important prognostic molecular biomarker for gastric cancer (GC). MSI status may be detected by immunohistochemistry (IHC) for mismatch repair (MMR) proteins and polymerase chain reaction (PCR). Idylla™ MSI assay has not been validated for GC but may prove to be a valid alternative. METHODS: In a series of 140 GC cases, MSI status was evaluated by IHC for MLH1, PMS2, MSH2, and MSH6; gold-standard pentaplex PCR panel (PPP) (BAT-25, BAT-26, NR-21, NR-24, and NR-27); and Idylla. Statistical analysis was performed using SPSS 27.0. RESULTS: PPP identified 102 microsatellite stable (MSS) cases and 38 MSI-high cases. Only 3 cases showed discordant results. Compared with PPP, the sensitivity was 100% for IHC and 94.7% for Idylla. Specificity was 99% for IHC and 100% for Idylla. MLH1 IHC alone showed sensitivity and specificity of 97.4% and 98.0%, respectively. IHC identified three indeterminate cases; all were MSS according to PPP and Idylla. CONCLUSION: IHC for MMR proteins represents an optimal screening tool for MSI status in GC. If resources are limited, isolated MLH1 evaluation may constitute a valuable option for preliminary screening. Idylla may help detect rare MSS cases with MMR-loss and define MSI status in indeterminate cases.

Crucial workload variables in female-male elite Brazilian Beach Handball: An exploratory factor analysis.

This study aimed to identify the most important variables of male and female beach handball workload demands and compare them by sex. A total of 92 elite Brazilian beach handball players (54 male: age 22.1 ± 2.6 years, height 1.8 ± 0.5 m, weight 77.6 ± 13.4 kg; and 38 female: age 24.4 ± 5.5 years, height 1.7 ± 0.5 m, weight 67.5 ± 6.5 kg) were analyzed in 24 official matches during a four-day congested tournament. From 250 variables measured by the inertial measurement unit, fourteen were extracted for analysis using Principal Component Analysis as selection criteria. Five Principal Components (PC) were extracted that explained 81.2-82.8% of total variance (overview of workload demands during beach handball). Specifically, 36.2-39.3% was explained by PC1 (DistanceExpl, Distance, Distance4-7 km/h, and Acc), 15-18% by PC2 (AccMax, Acc3-4 m/s, Dec4-3 m/s), 10.7-12.9% by PC3 (JumpsAvg Take-Off, JumpsAvg Landing and PLRT), 8-9.4% by PC4 (Distance> 18.1 km/h, SpeedMax), and 6.7-7.7% by PC5 (HRAvg and Step Balance). Sex-related differences were found in the PC distribution of variables, as well as in selected variables (HRAvg, Dec4-3 m/s, Acc3-4 m/s, JumpsAvg Take-Off, JumpsAvg Landing, AccMax, Distance, Distance4-7 km/h, Acc, SpeedMax) with higher values in male players (p < .05). In conclusion, the sex-related PC distribution and workload demands in beach handball should consider for training design and injury prevention programs.

Limitations to coral recovery along an environmental stress gradient.

Positive feedbacks driving habitat-forming species recovery and population growth are often lost as ecosystems degrade. For such systems, identifying mechanisms that limit the re-establishment of critical positive feedbacks is key to facilitating recovery. Theory predicts the primary drivers limiting system recovery shift from biological to physical as abiotic stress increases, but recent work has demonstrated that this seldom happens. We combined field and laboratory experiments to identify variation in limitations to coral recovery along an environmental stress gradient at Ningaloo Reef and Exmouth Gulf in northwest Australia. Many reefs in the region are coral depauperate due to recent cyclones and thermal stress. In general, recovery trajectories are prolonged due to limited coral recruitment. Consistent with theory, clearer water reefs under low thermal stress appear limited by biological interactions: competition with turf algae caused high mortality of newly settled corals and upright macroalgal stands drove mortality in transplanted juvenile corals. Laboratory experiments showed a positive relationship between crustose coralline algae cover and coral settlement, but only in the absence of sedimentation. Contrary to expectation, coral recovery does not appear limited by the survival or growth of recruits on turbid reefs under higher thermal stress, but to exceptionally low larval supply. Laboratory experiments showed that larval survival and settlement are unaffected by seawater quality across the study region. Rather, connectivity models predicted that many of the more turbid reefs in the Gulf are predominantly self seeded, receiving limited supply under degraded reef states. Overall, we find that the influence of oceanography can overwhelm the influences of physical and biological interactions on recovery potential at locations where environmental stressors are high, whereas populations in relatively benign physical conditions are predominantly structured by local ecological drivers. Such context-dependent information can help guide expectations and assist managers in optimizing strategies for spatial conservation planning for system recovery.

Adherence to 24-hour movement guidelines in low-income Brazilian preschoolers and associations with demographic correlates.

BACKGROUND: The importance of movement behaviors for health is well known, although few studies have examined the adherence to movement guidelines in low-income preschoolers from a middle-income country, as Brazil. This study reports the proportion of preschoolers meeting the 24-hour movement guidelines and investigates its associations with demographic correlates in Brazilian low-income preschoolers. METHODS: Two hundred and seventy preschoolers (132 boys, means age = 3.97 ± 0.80) provided physical activity (PA) data (Actigraph wGT3X). Sleep duration, screen time, and social correlates were parent-reported. Preschoolers were classified as compliant/not compliant with the 24-hour movement guidelines. Relationships between compliance with movement behaviors guidelines and demographic correlates were calculated using a network analysis (Mplus 8.0; Rstudio). RESULTS: Preschoolers were active (273.52 ± 62.08 minutes/day of total PA), though moderate-to-vigorous physical activity (MVPA) time was below the guideline (58.68 ± 22.51 minutes/day); spent more than the recommended 60 minutes/day on screen time (169.91 ± 97.07 minutes/day); and slept less than 10 hours per night (9.44 ± 1.12 hours/day). Only 3% of the sample complied with the guidelines. PA showed the highest compliance (43%), compared to sleep duration (35%) and screen time (15%). Male sex was related to adherence to MVPA recommendations, while female sex, with adherence to total PA recommendations. Child's primary caregiver was the most important centrality indicator in the network. CONCLUSION: Only 3% of the assessed preschoolers are compliant with the 24-hour movement behaviors guidelines. Strategies to promote adherence to movement behaviors among low-income preschoolers should consider child's primary caregivers to support movement behaviors.

24-hour movement behaviors and fitness in preschoolers: A compositional and isotemporal reallocation analysis.

This study analyzed the associations between the 24-hour movement behaviors composition and fitness in preschoolers and investigated predicted changes in fitness when time in active behaviors is reallocated. This cross-sectional study was carried out with 270 preschoolers (132 boys; 3.97 ± 0.80 years-old). Light and moderate-to-vigorous physical activity (LPA and MVPA), and sedentary behavior (SB) were verified using an accelerometer. Sleep time was obtained through interviews with parents. Components of physical fitness (cardiorespiratory fitness-CRF, speed-agility, and lower-body muscular strength) were assessed using the PREFIT Battery. To verify the association between 24-hour movement behaviors and physical fitness, the compositional analysis was used, and for the time reallocation, the compositional isotemporal substitution analysis was used for active behaviors (LPA and MVPA). The daily composition, adjusted for body mass index, sex, and age, was significantly associated with CRF (P = .007; r2  = 0.29), speed-agility (P < .001; r2  = 0.14), and lower-body muscular strength (P = .01; r2  = 0.07). For CRF, the addition of MVPA, at the expense of any other behavior, was associated with significant improvements. For speed-agility and lower-body muscular strength, only reallocations between sleep and LPA yielded significant associations. The variation in CRF, speed-agility, and lower-body muscular strength was associated with the 24 hours movement composition, and reallocating 5, 10 or 15 minutes of SB or sleep for MVPA was significantly positive for CRF (P < .05). The present findings highlight the relevance of decreasing SB and increasing physical activity practice, particularly at high intensities, to promote a better CRF profile for preschoolers.

Twenty-four-hour movement behaviours and fundamental movement skills in preschool children: A compositional and isotemporal substitution analysis.

Studies that have analysed the association between the different movement behaviours and fundamental movement skills (FMS) have considered it in an independent manner, disregarding the compositional nature of 24-h movement behaviours (24-h MB). The aim of this study was to investigate the relationship between the 24-h MB and FMS in preschoolers using a compositional data analysis . Two hundred and four preschoolers (4.5 ± 0.8 years old; 101 boys) provided objectively assessed physical activity (PA) and sedentary behaviour (SB) data (Actigraph wGT3X), and FMS (TGMD-2). Sleep duration (SD) was reported by parents. Association of daily composition of movement behaviours with FMS was explored using compositional analysis and isotemporal substitution (R Core Team, 3.6.1). When considered as a 24-h MB composition (PA, SB and SD), adjusted for age, BMI and sex, the composition predicted locomotor (r2 = 0.31), object control (r2 = 0.19), and total motor score (r2 = 0.35), respectively (all P < 0.001). Reallocation of time from light to moderate-to-vigorous PA was associated with greatest positive changes in total motor score. Achieving adequate balance between movement behaviours over the 24-h period, and its relationship with locomotor and object control skills should be considered and further investigated in early childhood.

Meningioma and breast cancer: survival of patients with synchronous and metachronous meningioma and breast cancer.

The prognosis of the association between Breast Cancer (BC) and Meningioma (M) is unknown. To evaluate the survival impact of tumor exposure sequence in patients with both tumors. Patients were divided in groups according to the tumors sequence: BC before M (group 1), synchronous BC + M (group 2) and BC after M (group 3). The SEER database was used. Demographics, meningioma and breast cancer variables were analyzed. The primary outcome was oncological survival. A total of 1715 patients were included (median follow-up:84 months). Group 2 had the shortest survival (median:32 months) and group 1 the longest (median:110 months). On the unadjusted analysis, group 2 had the shortest survival (HR:3.13, 95% CI 1.62-6.04) and adjusted analysis confirmed this finding (HR 3.11, 95% CI 1.58-6.19), with no statistical difference between the metachronous tumors groups. Increasing age (HR:1.13, 95% CI 1.11-1.15, p < 0.005) and grade III meningioma (HR:4.51, 95% CI 1.90-10.69, p < 0.005) were related with lower survival. Meningioma treatment had no influence on the survival (p > 0.05). The association between surgery and radiotherapy in BC treatment improved the outcome (HR 0.37, 95% CI 0.23-0.93, p < 0.05). Grade III meningioma and receptor hormonal status influenced synchronous tumors (p < 0.05) but had no influence on metachronous tumors survival (p > 0.05) on stratified analysis. Synchronous tumors were associated with lower survival. Increasing age had a negative influence on patient survival. Although surgery and radiotherapy for breast cancer had a positive influence in the outcome, meningioma treatment was not related with survival. Grade III meningioma and hormonal receptor status only influenced synchronous tumors patient survival.

Effect of a pilot multi-component intervention on motor performance and metabolic risks in overweight/obese youth.

This study evaluated the effect of a multi-component intervention on motor performance (MP) and metabolic risk markers (MRM) in overweight/obese youth. A secondary aim was to examine whether changes in MP are associated to changes in MRM. A 3-month multi-component intervention was performed, consisting of physical exercise sessions (twice/week;1h), nutritional education sessions (once/month), and parental support (twice/week). The sample included 35 volunteers (7-13 y.o), allocated to intervention (INT, n = 17) and control (CONT, n = 18) group. Variables were measured pre (T0) and post intervention (T1). Fasting blood samples were analyzed for MRM. MP tests included the measurement of health related physical fitness components and motor coordination performance (KTK battery). To assess food intake, a 24-hour recall diary was used. GLM-ANCOVA was performed. Standardized scores were calculated for the outcome variables, and multilinear regressions were applied to analyze associations between the key variables. INT group showed improvements in MP, glycolytic and hepatic profiles. After adjustments for MVPA, SB, total intake and maturational stage, negative associations between %ΔMP and %Δglycolytic (ß = -.424; 95%CI:-0.343:-0.022), and %Δhepatic scores (ß = -.382 95%CI:-0.001:-0.009) were observed. The intervention produced a moderate-to-high effect on the MP and some MRM. Changes in MP were inversely associated with changes in glycolytic and hepatic markers.

Predicting progression of mild cognitive impairment to dementia using neuropsychological data: a supervised learning approach using time windows.

BACKGROUND: Predicting progression from a stage of Mild Cognitive Impairment to dementia is a major pursuit in current research. It is broadly accepted that cognition declines with a continuum between MCI and dementia. As such, cohorts of MCI patients are usually heterogeneous, containing patients at different stages of the neurodegenerative process. This hampers the prognostic task. Nevertheless, when learning prognostic models, most studies use the entire cohort of MCI patients regardless of their disease stages. In this paper, we propose a Time Windows approach to predict conversion to dementia, learning with patients stratified using time windows, thus fine-tuning the prognosis regarding the time to conversion. METHODS: In the proposed Time Windows approach, we grouped patients based on the clinical information of whether they converted (converter MCI) or remained MCI (stable MCI) within a specific time window. We tested time windows of 2, 3, 4 and 5 years. We developed a prognostic model for each time window using clinical and neuropsychological data and compared this approach with the commonly used in the literature, where all patients are used to learn the models, named as First Last approach. This enables to move from the traditional question "Will a MCI patient convert to dementia somewhere in the future" to the question "Will a MCI patient convert to dementia in a specific time window". RESULTS: The proposed Time Windows approach outperformed the First Last approach. The results showed that we can predict conversion to dementia as early as 5 years before the event with an AUC of 0.88 in the cross-validation set and 0.76 in an independent validation set. CONCLUSIONS: Prognostic models using time windows have higher performance when predicting progression from MCI to dementia, when compared to the prognostic approach commonly used in the literature. Furthermore, the proposed Time Windows approach is more relevant from a clinical point of view, predicting conversion within a temporal interval rather than sometime in the future and allowing clinicians to timely adjust treatments and clinical appointments.

Physical Activity is Related to Fatty Liver Marker in Obese Youth, Independently of Central Obesity or Cardiorespiratory Fitness.

UNLABELLED: Nonalcoholic fatty liver disease (NAFLD) is one of the most frequent complications associated with excess adiposity and has been identified as the leading cause of liver disease in pediatric populations worldwide. Because cardiorespiratory fitness (CRF) is related to physical activity (PA) levels, and increased PA plays a protective role against NAFLD risk factors, the aim of this study was to analyze the association between PA and a fatty liver marker (alanine aminotransferase - ALT) in obese children and adolescents, independently of central adiposity or CRF. 131 obese children (83 girls, 7-15 year-olds) involved in a PA promotion program comprised the sample. Measurements included anthropometric and body composition evaluations (DEXA), biological measurements (venipuncture), CRF (progressive treadmill test), PA (accelerometry), and maturational stage (Tanner criteria). The associations between ALT with PA intensities, central obesity, and CRF were calculated by three different models of linear regression, adjusted for potential confounders. Level of significance was set at 95%. RESULTS: ALT was negatively associated with MVPA (ß = -0.305), and CRF (ß = -0.426), and positively associated with central obesity (ß=.468). After adjustment for central obesity the negative and statistically significant association between ALT with MVPA (ß = -0.364) and CRF (ß = -0.550) still persists while a positive and significantly correlation was shown between ALT and SB (ß = 0.382). Additional adjustment for CRF (Model 3) showed significant associations for all the PA intensities analyzed including light activity. PA at different intensities is associated to a fatty liver marker in obese children and adolescents, independently of central adiposity or CRF. Key pointsIn a previous study our group observed that there might be a potential protective effect of cardiorespiratory fitness (CRF) against abnormal ALT values;Considering that CRF is related to physical activity (PA), and increased PA plays a protective role against fatty liver, we hypothesized that it might be an association between PA and fatty liver in obese youth, independently of central adiposity or CRF;No other study has investigated these associations in obese youth;Our findings stresses the fact that moderate-to-vigorous and light physical activities, as well as lower sedentary behavior, is associated with lower fatty liver marker, independent of the effect of potential mediators, such as central obesity or CRF.

Motor Competence and Body Mass Index in the Preschool Years: A Pooled Cross-Sectional Analysis of 5545 Children from Eight Countries.

BACKGROUND AND OBJECTIVE: One in five preschool children are overweight/obese, and increased weight status over time increases the risks of poorer future health. Motor skill competence may be a protective factor, giving children the ability to participate in health-enhancing physical activity. Yet, we do not know when the relationship between motor competence and weight status first emerges or whether it is evident across the body mass index (BMI) spectrum. This study examined the association between motor skill competence and BMI in a multi-country sample of 5545 preschoolers (54.36 ± 9.15 months of age; 50.5% boys) from eight countries. METHODS: Quantile regression analyses were used to explore the associations between motor skill competence (assessed using the Test of Gross Motor Development, Second/Third Edition) and quantiles of BMI (15th; 50th; 85th; and 97th percentiles), adjusted for sex, age in months, and country. RESULTS: Negative associations of locomotor skills, ball skills, and overall motor skill competence with BMI percentiles (p < 0.005) were seen, which became stronger at the higher end of the BMI distribution (97th percentile). Regardless of sex, for each raw score point increase in locomotor skills, ball skills, and overall motor skill competence scores, BMI is reduced by 8.9%, 6.8%, and 5.1%, respectively, for those preschoolers at the 97th BMI percentile onwards. CONCLUSIONS: Public health policies should position motor skill competence as critical for children's obesity prevention from early childhood onwards. Robust longitudinal and experimental designs are encouraged to explore a possible causal pathway between motor skill competence and BMI from early childhood.

Role of Endoscopic Biopsies and Morphologic Features in Predicting Microsatellite Instability Status in Gastric Cancer: A Multicenter Comparative Study of Endoscopic Biopsies and Surgical Specimens.

Evaluation of mismatch repair (MMR) protein and microsatellite instability (MSI) status plays a pivotal role in the management of gastric cancer (GC) patients. In this study, we aimed to evaluate the accuracy of gastric endoscopic biopsies (EBs) in predicting MMR/MSI status and to uncover histopathologic features associated with MSI. A multicentric series of 140 GCs was collected retrospectively, in which EB and matched surgical specimens (SSs) were available. Laurén and WHO classifications were applied and detailed morphologic characterization was performed. EB/SS were analyzed by immunohistochemistry (IHC) for MMR status and by multiplex polymerase chain reaction (mPCR) for MSI status. IHC allowed accurate evaluation of MMR status in EB (sensitivity: 97.3%; specificity: 98.0%) and high concordance rates between EB and SS (Cohen κ=94.5%). By contrast, mPCR (Idylla MSI Test) showed lower sensitivity in evaluating MSI status (91.3% vs. 97.3%), while maintaining maximal specificity (100.0%). These results suggest a role of IHC as a screening method for MMR status in EB and the use of mPCR as a confirmatory test. Although Laurén/WHO classifications were not able to discriminate GC cases with MSI, we identified specific histopathologic features that are significantly associated with MMR/MSI status in GC, despite the morphologic heterogeneity of GC cases harboring this molecular phenotype. In SS, these features included the presence of mucinous and/or solid components ( P =0.034 and <0.001) and the presence of neutrophil-rich stroma, distant from tumor ulceration/perforation ( P <0.001). In EB, both solid areas and extracellular mucin lakes were also discriminating features for the identification of MSI-high cases ( P =0.002 and 0.045).

Swollen Finger - An Atypical Place for a Metastatic Lesion.

Acrometastasis, referring to metastases located distal to the elbow and knee, is a rare observation. The most common primary cancer site is the lungs, followed by colorectal, breast and genitourinary tract locations. We present a case of a 54-year-old woman with a 25-pack-year smoking history, chronic obstructive pulmonary disease and squamous cell carcinoma of the lung diagnosed at age 50. Upon physical examination, in the distal phalanx of the fourth finger of the right hand, there was a hypervascularized swelling, purplish and painful. Distal amputation of the fourth finger was performed with pathological anatomy compatible with acrometastasis of primary squamous cell carcinoma of the lung. Clinicians should be aware of this type of metastasis because it is sometimes difficult to distinguish from tuberculous dactylitis and other types of osteomyelitis in patients with undiagnosed cancer. The presence of acrometastasis confers a poor prognosis. LEARNING POINTS: Acrometastasis is a rare presentation of bone metastases.The diagnosis of acrometastasis is a challenge, due to the large number of differential diagnoses and the difficulty in detecting them early.The presence of acrometastasis confers a poor prognosis.

Pharmacist Intervention in Portuguese Older Adult Care.

Healthy ageing has become one of the most significant challenges in a society with an increasing life expectancy. Older adults have a greater prevalence of chronic disease, with the need for multiple medications to appropriately control these issues. In addition to their health concerns, ageing individuals are prone to loneliness, dependence, and economic issues, which may affect their quality of life. Governments and health professionals worldwide have developed various strategies to promote active and healthy ageing to improve the quality of life of older adults. Pharmacists are highly qualified health professionals, easily accessible to the population, thus playing a pivotal role in medication management. Their proximity to the patient puts them in a unique position to provide education and training to improve therapeutic adherence and identify medication-related problems. This paper aims to address the importance of Portuguese community pharmacists in the medication management of older adults, emphasising their intervention in health promotion, patient education, medication-related problems, deprescription, dose administration aids, and medication review and reconciliation. We also discuss home delivery services and medication management in long-term care facilities.

Sport-Specific Skills Differentiate Performance Levels Better Than Anthropometric or Physiological Factors in Beach Handball.

Beach handball is characterized by high- and low-intensity efforts on an unstable surface. Players are expected to display high levels of physical performance on sand, though there are no data concerning success in elite players. Purpose: This study aimed to address anthropometric, fitness, and sport-specific skills components in beach handball, by comparing elite national team beach handball players (world champions) to sub-elite players (playing at a regular club). Method: A total of 91 senior players (more than 21 years old) of both genders (19 world champions) were assessed for anthropometry, 5-m acceleration, 15-m sprint, handgrip strength, horizontal jump, and three specific sport-specific skills (ball velocities in standing, inflight and spin throwing) at a beach court. Anthropometric, physiological, and sport-specific skill test variables were analyzed as a multiple dependent variable using a multivariate analysis of variance (MANOVA) with sex and level (elite vs sub-elite) as the fixed factors. SPSS (25.0) was used, significance was assumed at p < .05. Results: The results highlighted that for male and female athletes, horizontal jump, 6-m standing, spin, and inflight throwing discriminated between elite and sub-elite groups (p < .001). Conclusion: The study suggests that the factors which differentiate between elite and sub-elite performers in beach handball are horizontal jump and technical ability via the performance of specific throwing skills, rather than anthropometric or any other physical variables, irrespective of sex. These findings highlight some of the relevant physical capacities and skills that need to be developed over the years of preparation of top-level beach handball players.

The Prevalence of Polypharmacy and Potentially Inappropriate Medications and Its Relationship with Cognitive Status in Portuguese Institutionalized Older Adults: A Cross-Sectional Study.

The aim of this study was to evaluate the prevalence of polypharmacy and potentially inappropriate medications (PIMs) in a population of older adults living in nursing homes. Furthermore, we also intended to assess the possible association between polypharmacy, potentially inappropriate medications and cognitive impairment in institutionalized older adults. A cross-sectional study analyzed data from 193 nursing home residents in the district of Viseu, Portugal, between September 2018 and June 2019, with a mean age of 82.4 ± 6.2 years (ranging from 65 to 95 years old); 72.5% (n = 140) were female participants. Major polypharmacy was presented in 80.8% of the study population, who took 7.6 ± 3.3 drugs per day. Using the Beers Criteria, we found that 79.3% took PIMs. There was a positive association between polypharmacy and PIM (p < 0.001), showing that higher medicines intake increased the number of PIMs. Polypharmacy was not associated with the functionality of the older adults to perform activities of daily living, but was associated with cognitive impairment. The older adults with lower scores on the Mini Mental State Examination (MMSE) took more drugs (p = 0.039) and used more PIM (p < 0.001). Moreover, patients taking five or more prescription drugs per day (major polypharmacy) consuming any psychiatric, gastrointestinal or oral antidiabetic agents (regardless of whether they were considered potentially inappropriate or not) had higher odds of displaying cognitive impairment than those who did not (p < 0.05). Older adult residents of the studied nursing homes were potentially affected by polypharmacy and inappropriate polypharmacy. This observation reveals the need to adopt and implement strategies that make drug therapy more adequate and safer for older adults.

EBV and MSI Status in Gastric Cancer: Does It Matter?

We investigated the impactof microsatellite instability (MSI) and Epstein-Barr virus (EBV) status in gastric cancer (GC), regarding response to perioperative chemotherapy (POPChT), overall survival (OS), and progression-free survival (PFS). We included 137 cases of operated GC, 51 of which were submitted to POPChT. MSI status was determined by multiplex PCR and EBV status by EBV-encoded RNA in situ hybridization. Thirty-seven (27%) cases presented as MSI-high, and seven (5.1%) were EBV+. Concerning tumor regression after POPChT, no differences were observed between the molecular subtypes, but females were more likely to respond (p = 0.062). No significant differences were found in OS or PFS between different subtypes. In multivariate analysis, age (HR 1.02, IC 95% 1.002-1.056, p = 0.033) and positive lymph nodes (HR 1.82, IC 95% 1.034-3.211, p = 0.038) were the only prognostic factors for OS. However, females with MSI-high tumors treated with POPChT demonstrated a significantly increased OS compared to females with MSS tumors (p = 0.031). In conclusion, we found a high proportion of MSI-high cases. MSI and EBV status did not influence OS or PFS either in patients submitted to POPChT or surgery alone. However, superior survival of females with MSI-high tumors suggests that sex disparities and molecular classification may influence treatment options in GC.

Lymph node yield in the pathological staging of resected nonmetastatic colon cancer: The more the better?

INTRODUCTION: Guidelines recommend regional lymphadenectomy with a lymph node yield (LNY) of at least 12 lymph nodes (LN) for adequate colon cancer (CC) staging. LNY ≥22LN may improve survival, especially in right-sided CC [Lee et al., Surg Oncol, 27(3), 2018]. This multicentric retrospective cohort study evaluated the impact of LNY and tumor laterality on CC staging and survival. MATERIALS AND METHODS: Patients with stage I-III CC that underwent surgery from 2012 to 2018 were grouped according to LNY: <22 and ≥ 22. Primary outcomes were LN positivity (N+ rate) and disease-free survival (DFS). Overall survival (OS) was the secondary outcome. Exploratory analyses were performed for laterality and stage. RESULTS: We included 795 patients (417 < 22LN, 378 ≥ 22LN); 53% had left-sided CC and 29%/37%/38% had stage I/II/III tumors. There was no association between LNY ≥22LN and N+ rate after adjustment for grade, T stage, lymphovascular invasion (LVI) and perineural invasion; a trend for a higher N+ rate in left-sided CC was identified (interaction p = 0.033). With a median follow-up of 63.6 months for DFS and 73.2 months for OS, 254 patients (31.9%) relapsed and 207 (26.0%) died. In multivariate analysis adjusted for age, ASA score, laparoscopic approach, T/N stage, mucinous histology, LVI and adjuvant chemotherapy, LNY ≥22LN was significantly associated with both DFS (HR 0.75, p = 0.031) and OS (HR 0.71, p = 0.025). Restricted cubic spline analysis showed a more significant benefit for right-sided CC. CONCLUSION: LNY ≥22LN was associated with longer DFS and OS in patients with operable CC, especially for right-sided CC.