Deep learning and automatic differentiation of pancreatic lesions in endoscopic ultrasound - a transatlantic study.

Endoscopic ultrasound (EUS) allows characterization and biopsy of pancreatic lesions. Pancreatic cystic neoplasms (PCN) include in mucinous (M-PCN) and non-mucinous lesions (NM-PCN). Pancreatic ductal adenocarcinoma (P-DAC) is the commonest pancreatic solid lesion (PSL), followed by pancreatic neuroendocrine tumor (P-NET). While EUS is preferred for pancreatic lesion evaluation, its diagnostic accuracy is suboptimal. This multicentric study aims to develop a convolutional neural network (CNN) for detecting and distinguishing PCN (namely M-PCN and NM-PCN) and PSL (particularly P-DAC and P-NET). A CNN was developed with 378 EUS exams from 4 international reference centers (Centro Hospitalar Universitário São João, Hospital Universitario Puerta de Hierro Majadahonda, New York University Hospitals, Hospital das Clínicas FMUSP). 126.000 images were obtained - 19.528 M-PCN, 8.175 NM-PCN, 64.286 P-DAC, 29.153 P-NET and 4.858 normal pancreas images. A trinary CNN differentiated normal pancreas tissue from M-PCN and NM-PCN. A binary CNN distinguished P-DAC from P-NET. The total dataset was divided in a training and testing dataset (used for model's evaluation) in a 90/10% ratio. The model was evaluated through its sensitivity, specificity, positive and negative predictive values and accuracy. The CNN had 99.1% accuracy for identifying normal pancreatic tissue, 99.0% and 99.8% for M-PCN and NM-PCN, respectively. P-DAC and P-NET were distinguished with 94.0% accuracy. Our group developed the first worldwide CNN capable of detecting and differentiating the commonest PCN and PSL in EUS images, using exams from 4 centers in two continents, minimizing the impact of the demographic bias. Larger multicentric studies are needed for technology implementation.

A Comprehensive Review of Artificial Intelligence and Colon Capsule Endoscopy: Opportunities and Challenges.

Colon capsule endoscopy (CCE) enables a comprehensive, non-invasive, and painless evaluation of the colon, although it still has limited indications. The lengthy reading times hinder its wider implementation, a drawback that could potentially be overcome through the integration of artificial intelligence (AI) models. Studies employing AI, particularly convolutional neural networks (CNNs), demonstrate great promise in using CCE as a viable option for detecting certain diseases and alterations in the colon, compared to other methods like colonoscopy. Additionally, employing AI models in CCE could pave the way for a minimally invasive panenteric or even panendoscopic solution. This review aims to provide a comprehensive summary of the current state-of-the-art of AI in CCE while also addressing the challenges, both technical and ethical, associated with broadening indications for AI-powered CCE. Additionally, it also gives a brief reflection of the potential environmental advantages of using this method compared to alternative ones.

Single-cell Transcriptomic Analysis Identifies Senescent Osteocytes that Trigger Bone Destruction in Breast Cancer Metastasis.

Breast cancer bone metastases increase fracture risk and are a major cause of morbidity and mortality among women. Upon colonization by tumor cells, the bone microenvironment undergoes profound reprogramming to support cancer progression, which disrupts the balance between osteoclasts and osteoblasts and leads to bone lesions. A deeper understanding of the processes mediating this reprogramming could help develop interventions for treating patients with bone metastases. Here, we demonstrated that osteocytes in established breast cancer bone metastasis develop premature senescence and a distinctive senescence-associated secretory phenotype (SASP) that favors bone destruction. Single-cell RNA sequencing identified osteocytes from mice with breast cancer bone metastasis enriched in senescence, SASP markers, and pro-osteoclastogenic genes. Multiplex in situ hybridization and AI-assisted analysis depicted osteocytes with senescence-associated satellite distension, telomere dysfunction, and p16Ink4a expression in mice and patients with breast cancer bone metastasis. Breast cancer cells promoted osteocyte senescence and enhanced their osteoclastogenic potential in in vitro and ex vivo organ cultures. Clearance of senescent cells with senolytics suppressed bone resorption and preserved bone mass in mice with breast cancer bone metastasis. These results demonstrate that osteocytes undergo pathological reprogramming by breast cancer cells and identify osteocyte senescence as an initiating event triggering lytic bone disease in breast cancer metastases.

Exploring first-degree family history in a cohort of Portuguese Alzheimer's disease patients: population evidence for X-chromosome linked and recessive inheritance of risk factors.

BACKGROUND: Alzheimer's disease (AD) heritability is estimated to be around 70-80%. Yet, much of it remains to be explained. Studying transmission patterns may help in understanding other factors contributing to the development of AD. OBJECTIVE: In this study, we aimed to search for evidence of autosomal recessive or X- and Y-linked inheritance of risk factors in a large cohort of Portuguese AD patients. METHODS: We collected family history from patients with AD and cognitively healthy controls over 75 years of age. We compared the proportions of maternal and paternal history in male and female patients and controls (to search for evidence of X-linked and Y-linked inherited risk factors). We compared the risk of developing AD depending on parents' birthplace (same vs. different), as a proxy of remote consanguinity. We performed linear regressions to study the association of these variables with different endophenotypes. RESULTS: We included 3090 participants, 2183 cognitively healthy controls and 907 patients with AD. Men whose mother had dementia have increased odds of developing AD comparing to women whose mother had dementia. In female patients with a CSF biomarker-supported diagnosis of AD, paternal history of dementia is associated with increased CSF phosphorylated Tau levels. People whose parents are from the same town have higher risk of dementia. In multivariate analysis, this proxy is associated with a lower age of onset and higher CSF phosphorylated tau. CONCLUSIONS: Our study gives evidence supporting an increased risk of developing AD associated with an X-linked inheritance pattern and remote consanguinity.

Association between the practice of fitness-related exercises and body image dissatisfaction in adolescents from Curitiba (PR), Brazil.

OBJECTIVE: The aim of this study was to analyze the association between participation in fitness-related exercises (FRE) and body image dissatisfaction (BID) in adolescents and evaluate the interaction between physical exercise and nutritional status in this association. METHODS: A cross-sectional study was conducted in 2015 involving 799 adolescents (10-16 years old) from 14 public schools in Curitiba (PR), Brazil. BID was assessed using the Body Shape Questionnaire and the Silhouette Scale. The FRE was classified as "does not practice," "practices ≤300 min/week," and "practices >300 min/week" by the Physical Activity Questionnaire for Adolescents. Poisson and multinomial logistic regressions, adjusted for sex, sexual maturation, and nutritional status analyzed the association of FRE and BID. RESULTS: The BID prevalence was 28.3%; 52.4% of the adolescents wanted to reduce their silhouettes; and 48.7% did not practice FRE. Adolescents who practiced FRE >300 min/week had a 28% higher prevalence for some level of BID (PR 1.28; 95%CI 1.08-1.52) and a 46% lower chance of wanting to reduce silhouettes (OR 0.54; 95%CI 0.35-0.82), compared to nonpractitioners. There was no interaction between FRE and nutritional status in association with BID. CONCLUSIONS: The adolescents who practice FRE >300 min/week are likely to have some level of BID and are less likely to report the desire to increase their silhouettes, regardless of their nutritional status.

Índice cpod e fatores associados dos moradores de um município de pequen o porte no nordeste brasileiro / DMF index and associated factors of residents in a small municipality in Northeast Brazil / Índice CPO y factores asociados de los residentes de un pequeño municipio en el noreste de Brasil

Introdução:A atenção à Saúde Bucal no Brasil foi qualificada a partir da Política Nacional de Saúde Bucal (PNSB), através do Sistema Único de Saúde (SUS), fomentando ações de promoção, prevenção e recuperação da saúde bucal da população. A avaliação da prevalência de cárie dentária em determinada comunidade, para Estudos Epidemiológicos em Saúde Bucal, pode ser realizada por meio do índice CPOD, que fornece a quantidade média de dentes cariados, perdidos e obturados. Objetivo:O presente trabalho objetivouaferir o índice CPOD dos moradores de uma área coberta pela Equipe de Saúde Bucal (ESB) de um município de pequeno porte, caracterizar seu perfil socioeconômico, verificar seu comportamento quanto ao uso de serviços odontológicos e identificar fatores associados ao índice. Metodologia:Foi realizado um estudo de prevalência do tipo exploratório e descritivo com abordagem quantitativaem residentes de um município de pequeno porte com cobertura pela Equipe de Saúde Bucal. Foi utilizado um questionário de caracterização individual abordando identificação socioeconômica e comportamento relacionado à saúde bucal.Resultados:Na análise do CPOD, a média de dentes perdidos (5,44) foi maior que a dos dentes obturados (4,31) e cariados (1,34). Odesfecho CPOD foi associado positivamente com a idade e a necessidade do uso de prótese dentária.Conclusões:Observou-se uma média mais alta de dentes perdidos, seguida por dentes obturados, e uma média menor de dentes cariados. Verificamos que o índice CPOD individual foi mais elevado em pessoas com mais de 34 anos e naqueles que necessitavam de próteses dentárias (AU).

Introduction:Oral Health care in Brazil was qualified basedon the National Oral Health Policy (PNSB), through the Unified Health System (SUS), promoting actions to promote, prevent and recover the oral healthof the population. Assessing the prevalence of tooth decay in a community, for Epidemiological Studies inOral Health, can be conductedusing the DMFT index, which provides the average number of Decayed, Missing and Filled Teeth. Objective:Thisstudy aimed to measure the DMFT index of residents of an area covered by anOral Health Team (ESB) of a small municipality, characterize their socioeconomic profile, verify their behavior regarding the use of dental services,and identify factors associated with this index. Methodology:An exploratory and descriptive prevalence study was conductedwith a quantitative approach in residents of a small municipality covered by the Oral Health Team. An individual characterization questionnaire addressing socioeconomic identification and behavior related to oral health was used. Results:The total samplewas of 283 individuals with an average of 34 years of age. In the DMFT analysis, the average number of missing teeth (5.44) was higher than that of filled (4.31) and decayed ones(1.34). The occurrence of a DMFTindexgreater than 11 was significantly higher in individuals over 34 years of age (p value 0.000) and in subjects who needed dental prosthesis (p value 0.001). Conclusions:A higher average of missing teeth was observed, followed by filled ones, and a lower average of decayed teeth. The DMFT outcome was positively associated with age and the need to use dental prostheses (AU).

Introducción:La atención a la salud bucal en Brasil ha sido calificada por la Política Nacionalde Saúde Bucal (PNSB), a través del Sistema Único de Saúde (SUS), promoviendo acciones de promoción, prevención y recuperación de la salud bucal de la población. Para estudios epidemiológicos de salud bucal, la prevalencia de caries dental en una determinada comunidad puede ser evaluada utilizando el índice DMFT, que proporciona el número medio de dientes cariados, perdidos y obturados. Objetivo:El objetivo de este estudio fue medir el índice DMFT de los residentes de un área cubierta por el Equipo de Salud Bucal (ESB) de un pequeño municipio, caracterizar su perfil socioeconómico, verificar su comportamiento en cuanto al uso de servicios odontológicos e identificar factores asociados al índice. Metodología:Se realizó un estudio exploratorio y descriptivo de prevalencia con abordaje cuantitativo en residentes de un pequeño municipio cubierto por un Equipo de Salud Bucal. Se utilizó un cuestionario de caracterización individual que abordaba la identificación socioeconómica y el comportamiento relacionado conla salud bucodental. Resultados:La muestra total fue de 283 individuos con una edad media de 34 años. En el análisis de la DMFT, la media de dientes ausentes (5,44) fue superior a la de dientes obturados (4,31) y cariados (1,34). La incidencia de un DMFTsuperior a 11 fue significativamente mayor en los individuos de más de 34 años (valor p 0,000) y en los que necesitaban un tratamiento dental. Conclusiones:Hubo un mayor número medio de dientes ausentes, seguido de dientes obturados, y un menor número medio de dientes cariados. El resultado del DMFT se asoció positivamente con la edad y la necesidad de prótesis dentales (AU).

Mitochondrial protein deacetylation by SIRT3 in osteoclasts promotes bone resorption with aging in female mice.

OBJECTIVES: The mitochondrial deacetylase sirtuin-3 (SIRT3) is necessary for the increased bone resorption and enhanced function of mitochondria in osteoclasts that occur with advancing age; how SIRT3 drives bone resorption remains elusive. METHODS: To determine the role of SIRT3 in osteoclast mitochondria, we used mice with conditional loss of Sirt3 in osteoclast lineage and mice with germline deletion of either Sirt3 or its known target Pink1. RESULTS: SIRT3 stimulates mitochondrial quality in osteoclasts in a PINK1-independent manner, promoting mitochondrial activity and osteoclast maturation and function, thereby contributing to bone loss in female but not male mice. Quantitative analyses of global proteomes and acetylomes revealed that deletion of Sirt3 dramatically increased acetylation of osteoclast mitochondrial proteins, particularly ATPase inhibitory factor 1 (ATPIF1), an essential protein for mitophagy. Inhibition of mitophagy via mdivi-1 recapitulated the effect of deletion of Sirt3 or Atpif1 in osteoclast formation and mitochondrial function. CONCLUSIONS: Decreasing mitophagic flux in osteoclasts may be a promising pharmacotherapeutic approach to treat osteoporosis in older adults.

Eco-friendly concrete: Combining treated wastewater and recycled aggregates.

The concrete industry is a significant consumer of drinking water and natural aggregates, such as sand and gravel. However, the scarcity of water and aggregate resources and the challenges associated with the disposal of construction and demolition waste prompted the exploration of alternative materials. This study investigates the feasibility of incorporating secondary treated wastewater from UASB reactors followed by trickling filters and mixed recycled aggregates as potential alternatives. To assess the viability of these alternatives, the study considered the replacement of 100% potable water with treated wastewater, as well as varying proportions of recycled gravel (20, 40, 60, 80, and 100%) and recycled sand (10, 20, 30, 40, and 100%). Physical and mechanical properties were negatively affected, but it was possible to reach compressive results over 40 MPa and splitting tensile strength over 4 MPa for almost all mixes. Regarding physical properties, the use of alternative materials caused poorer outcomes for density, water absorption, and air-void ratio. The limited magnitude of these detrimental effects indicates the potential of manufacturing concrete with the addition of combined treated wastewater and recycled aggregate as a viable strategy while enhancing reuse practices.

Discovery of Potent Isoquinolinequinone N-Oxides to Overcome Cancer Multidrug Resistance.

Multidrug resistance (MDR) of human tumors has resulted in an immediate need to develop appropriate new drugs. This work outlines the development of 20 potent IQQ N-oxide derivatives in two isomeric families, both exhibiting nanomolar GI50 against human tumor cell lines. Preliminary NCI-60 tumor screening sees the C(6) isomers achieve a mean GI50 > 2 times lower than the corresponding C(7) isomers. MDR evaluation of nine selected compounds reveals that each presents lower GI50 concentrations in two MDR tumor cell lines. Four of the series display nanomolar GI50 values against MDR cells, having selectivity ratios up to 2.7 versus the sensitive (parental) cells. The most potent compound 25 inhibits the activity of drug efflux pumps in MDR cells, causes significant ROS accumulation, and potently inhibits cell proliferation, causing alterations in the cell cycle profile. Our findings are confirmed by 3D spheroid models, providing new candidates for studies against MDR cancers.

Association between lifestyle-related risk behaviors, chronic diseases, and body image distortion: gender differences in follow-up 1 of the ELSA-Brasil cohort.

Aim: To determine the prevalence of body image accuracy/distortion in Brazilian men and women and to investigate sociodemographic and lifestyle-related factors, and the presence of chronic diseases associated with body image distortion. Methods: Data from 6,357 men and 7,657 women participating in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) were collected using a multidimensional questionnaire covering sociodemographic characteristics, health behaviors, heath conditions and body image perception. Results: Most participants (53.5% of the women and 54.7% of the men) were found to have an accurate self-perception of their body. When the factors associated with the perception of being heavier than reality were investigated, adopting weight loss measures and not being hypertensive proved protective against this distortion, both in women and men. Conversely, the perception of being lighter than reality was associated, in both women and men, with better education, being black or of mixed race, adopting weight loss measures and not being hypertensive or diabetic. Additional factors associated with underestimating weight were not consuming alcohol (only in women) and belonging to a lower social class (only in men). Conclusion: These findings may contribute to the implementation of public health policies and interventions to promote health and well-being in the Brazilian population.

Are Neighborhood Greenspaces Associated with Leisure-time Physical Activity? Results from ELSA-Brasil Eight-year Follow-up.

We investigated whether neighborhood greenspaces were associated with physical activity in adulthood over 3 cohort visits after considering perceived safety and neighborhood contextual factors. We also evaluated whether the association with greenspace varied by neighborhood socioeconomic status. Participants (N = 4,800) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) residing in two Brazilian state capitals were evaluated in Visits 1 (2008-2010), 2 (2012-2014) and 3 (2017-2019). Greenspaces were categorized by quintiles of positive Normalized Difference Vegetation Index (NDVI) scores. Physical activity frequency was given by the number of visits at which participants reported moderate/vigorous physical activity (none, 1 or 2, and 3 visits). We used multinomial logistic regression. After adjustment for age, sex, education, research center, residence in slums, individuals in the 4th and 5th NDVI quintiles showed 73% higher odds of physical activity over 3 visits than those in the 1st quintile (4th quintile: 95%CI = 1.24-2.43; 5th quintile: 95%CI = 1.24-2.41). The strength of the association was attenuated after adjustment for perceived safety. After adjustment for contextual factors quantity of sidewalks and streetlights, the OR for the 4th and 5th NDVI quintiles decreased to 1.66 (95%CI = 1.18-2.33) and 1.62 (95%CI = 1.16-2.28), respectively. Finally, after including average household income per capita, the OR for physical activity in 3 visits for the 4th and 5th NDVI quintiles decreased to 1.48 (95%CI = 1.04-2.12) and 1.43 (95%CI = 1.00-2.04; p = 0.053), respectively. Greater greenspace contributed to sustained physical activity during the eight years of follow-up, indicating the potential contribution of public greenspaces to reducing health-related inequalities.

Leisure Time Physical Activity and Incidence of Arterial Hypertension in ELSA-Brasil Participants. / Atividade Física no Tempo Livre e Incidência de Hipertensão Arterial em Participantes do ELSA-Brasil.

BACKGROUND: Evidence indicates that physical activity (PA) has a protective effect against chronic diseases, including high arterial hypertension (AH). OBJECTIVE: This study investigated, longitudinally, the association between changes in leisure time physical activity (LTPA) and the incidence of hypertension in ELSA-Brasil participants. METHODS: Data from 8,968 participants were analyzed at two different times (2008-2010 and 2012-2014). The International Physical Activity Questionnaire (IPAQ), long version, was used to assess LTPA. The association between LTPA and AH was tested using Poisson regression with relative risk (RR) estimation, with a significance level of 5% and a 95% confidence interval. RESULTS: When the LTPA level variable was categorized as sufficient and insufficient, no statistically significant associations were found between LTPA and AH incidence as a function of changes in PA during follow-up. However, when the LTPA variable was categorized as inactive, little active, active, and very active, a statistically significant association was observed between LTPA and AH in participants classified as very physically active. The risk of AH was reduced by 35% among men RR 0.65 (95% CI 0.50-0.86) and by 66% among women RR 0.34 (95% CI 0.20-0.58) who maintained high levels of LTPA at both moments of follow-up. CONCLUSION: These results suggest that maintaining high levels of PA over time is associated with a lower risk of developing AH, highlighting the importance of PA in preventing this condition, for both men and women.

FUNDAMENTO: Evidências apontam que a atividade física (AF) apresenta efeito protetor para as doenças crônicas, incluindo a hipertensão arterial (HA). OBJETIVO: Este estudo investigou, de forma longitudinal, a associação entre as mudanças na atividade física no tempo livre (AFTL) e a incidência de HA em participantes do ELSA-Brasil. MÉTODOS: Foram analisados dados de 8.968 participantes em dois momentos distintos (2008-2010 e 2012-2014). Foi utilizado o Questionário Internacional de Atividade Física (IPAQ), versão longa, para avaliação da AFTL. A associação entre AFTL e HA foi testada por regressão de Poisson com estimativa do risco relativo (RR), com nível de significância de 5% e intervalo de confiança de 95%. RESULTADOS: Quando a variável nível de AFTL foi categorizada em suficiente e insuficiente, não foram encontradas associações estatisticamente significantes entre AFTL e a incidência HA em função das mudanças na AF durante o seguimento. No entanto, a variável AFTL quando categorizada em inativo, pouco ativo, ativo e muito ativo, observou-se associação estatisticamente significante entre AFTL e HA em participantes classificados como muito ativos fisicamente. O risco de HA foi reduzido em 35% entre homens RR 0,65 (IC 95% 0,50-0,86) e em 66% entre as mulheres RR 0,34 (IC 95% 0,20-0,58) que mantiveram altos níveis de AFTL em ambos os momentos do seguimento. CONCLUSÃO: Esses resultados sugerem que a manutenção de altos níveis de AF ao longo do tempo está associada a um menor risco de desenvolver HA, destacando a importância da AF na prevenção dessa condição, tanto para homens quanto para mulheres.

Burden of respiratory syncytial virus infections in older adults with acute respiratory infection in Japan: An epidemiological study among outpatients.

BACKGROUND: Respiratory syncytial virus (RSV) is a leading cause of acute respiratory illness, with severe outcomes in older adults. Information on the prevalence, hospitalization rate, and impact on the health-related quality of life (HRQoL) of RSV in older adults with acute respiratory infections (ARI) in outpatient settings in Japan is limited. METHODS: This multi-center epidemiological study included outpatients aged ≥60 years presenting with ARI between August 2021 and February 2023. Nasal and throat swabs were collected and tested by reverse transcription polymerase chain reaction (RT-PCR). The prevalence of RT-PCR-confirmed RSV (cRSV)-ARI, cRSV-lower respiratory tract disease (LRTD), and other respiratory viruses was calculated by season, region, age group, and RSV subtype. HRQoL was assessed via patient-reported outcomes. RESULTS: The study included 923 ARI episodes (cRSV-ARI: N = 24; non-cRSV-ARI: N = 899). In years 1 and 2 (August 2021-July 2022 and August 2022-February 2023), the prevalence of cRSV-ARI was 2.5% and 2.8%, respectively. There was a predominance of RSV-B and RSV-A subtypes in years 1 and 2, respectively. In years 1 and 2 combined, 37.5% of cRSV-ARI cases had lower respiratory tract infection; all cRSV-LRTD cases occurred in those aged 60-74 years. RSV-ARI cases reported throat, chest, and respiratory symptoms, leading to impaired functioning and HRQoL. CONCLUSIONS: During the observed study period, RSV was circulating among older adults in Japan. RSV was a leading cause of ARI and LRTD. More data are needed to fully clarify the burden of RSV among older adults in Japan.

From Ovarian Hyperstimulation to the Discovery of a Liver Nodule.

Ovarian hyperstimulation syndrome (OHSS) is a complication of ovulation induction. Deep vein thrombosis (DVT) can occur as a consequence of this syndrome, but it is an infrequent event. The authors describe the case of a woman who became pregnant after ovulation induction and developed severe OHSS and, subsequently, DVT of the right brachiocephalic trunk, internal and external jugular veins, and right subclavian vein. Thrombophilia studies were positive, revealing the presence of four mutations. The pregnancy was bichorionic and biamniotic twins and, during the course of the pregnancy, she developed severe cholestasis. In the follow-up of this situation, she underwent abdominal ultrasound which revealed the presence of liver nodules. Three years after delivery, the patient remains anticoagulated and under surveillance of liver nodules by annual MRI.

Transthyretin monomers: a new plasma biomarker for pre-symptomatic transthyretin-related amyloidosis.

BACKGROUND: Genotyping and amyloid fibril detection in tissues are generally considered the diagnostic gold standard in transthyretin-related amyloidosis. Patients carry less stable TTR homotetramers prone to dissociation into non-native monomers, which rapidly self-assemble into oligomers and, ultimately, amyloid fibrils. Thus, the initial event of the amyloid cascade produces the smallest transthyretin species: the monomers. This creates engineering opportunities for diagnosis that remain unexplored. METHODS: We hypothesise that molecular sieving represents a promising method for isolating and concentrating trace TTR monomers from the tetramers present in plasma samples. Subsequently, immunodetection can be utilised to distinguish monomeric TTR from other low molecular weight proteins within the adsorbed fraction. A two-step assay was devised (ImmunoSieve assay), combining molecular sieving and immunodetection for sensing monomeric transthyretin. This assay was employed to analyse plasma microsamples from 10 individuals, including 5 pre-symptomatic carriers of TTR-V30M, the most prevalent amyloidosis-associated TTR variant worldwide, and 5 healthy controls. RESULTS: The ImmunoSieve assay enable sensitive detection of monomeric transthyretin in plasma microsamples. Moreover, the circulating monomeric TTR levels were significantly higher in carriers of amyloidogenic TTR mutation. CONCLUSIONS: Monomeric TTR can function as a biomarker for evaluating disease progression and assessing responses to therapies targeted at stabilising native TTR.

Obturator prostheses with intramucosal retention system in patients with maxillectomy.

PURPOSE: To evaluate the intramucosal retention system in patients' masticatory efficiency and quality of life in this case series. MATERIAL AND METHODS: A total of 3 individuals with maxillectomy were included for rehabilitation with a complete obturator prostheses with an intramucosal retention system (OPI). The complete obturator prostheses was made for 60 days, and electromyography assessments and bite force were applied before, after 30, 60, and 90 days of surgery and prostheses installation. The University of Washington Quality of Life Questionnaire (UW-QoL) and the Obturator Functional Scale (OFS) were also administered at baseline and in the same follow-up periods. The electromyography was evaluated on both sides of the masseter, temporalis, and buccinator muscles while chewing hard and soft food. The maximum bite force was recorded in the central incisors and both sides of the first molar region. RESULTS: Bite force values increased in the first molar region, and muscular electrical activity remained constant. Items related to the taste and swallowing of the UW-QOL impacted. Most OFS questionnaire data responses indicated that patients improved in swallowing liquid foods and appearance. CONCLUSIONS: The rehabilitative capacity improves masticatory efficiency and QoL in adults maxilectomized and rehabilitated with OPI analysis in the study. Further clinical studies should be encouraged to determine the effectiveness of this retentive system.

Empirical evidence of organizational transformation: The subsequent consequence of the causal relationship between the adoption of circular economy strategies and their performance.

The adoption of circular economy (CE) strategies by companies-such as reduction, substitution, reuse, and others-is more necessary than ever to face recent challenges that have caused a rise in the price of raw materials, among other effects. However, incorporating CE strategies into the production process is not trivial because it can imply significant organizational transformation. To understand this transformation, this work analyses how the adoption of CE strategies impacts company performance and, consequently, the subsequent transformation of the company in adapting to this strategy. Based on a sample of 213 senior managers from companies in the manufacturing and service sectors, structural equation modelling is performed to contribute empirical evidence to the literature. The findings reveal that the adoption of CE strategies by companies can be more profitable than solely pursuing financial outcomes, as such adoption also impacts external stakeholders, society in general, and customers in particular. However, in return, the company must be open to deploying a certain degree of organizational transformation.

Efficacy of Therapeutic Exercise in Reducing Pain in Instrumental Musicians: Systematic Review and Meta-Analysis.

Playing-related pain poses a significant health concern for musicians, often impacting their ability to perform. Therapeutic exercise emerges as a viable approach to alleviate these symptoms, offering a low-cost intervention with minimal side effects. This review seeks to examine and assess the efficacy of therapeutic exercise in reducing pain intensity among instrumental musicians. Three major databases (PubMed, Web of Science, and Scopus) were systematically searched from November 2023 to June 2024. The inclusion criteria required studies to be randomized clinical trials focusing on pain intensity in instrumental musicians, published in the last 10 years. Two independent researchers assessed the characteristics and methodological quality of the selected studies. Out of 305 identified studies, 15 underwent full-text reviews, with 5 ultimately included in the analysis. The total participant count was 273, with an average intervention duration of 32.5 min per session, twice weekly for eight weeks. Overall, therapeutic exercise interventions demonstrated favorable effects, with three studies exhibiting good methodological quality. The meta-analysis revealed significant positive results favoring exercise in reducing pain intensity, with positive responses observed across all clinical populations, so therapeutic exercise appears to be an effective approach for reducing pain intensity in musicians experiencing playing-related pain.

Bibliometric study and potential applications in the development of starch films with nanocellulose: A perspective from 2019 to 2023.

This study aimed to perform a bibliometric analysis of starch films with nanocellulose, using the Scopus database and VOSviewer and Bibliometrix software. A total of 258 documents were identified between 2019 and 2023, reflecting a growing interest in research, particularly in journals such as the International Journal of Biological Macromolecules, Polymers, and Carbohydrate Polymers. The most common terms were "starch" (349 occurrences), "cellulose" (207), and "tensile strength" (175). China (58 articles), Brazil (38), and India (33) led scientific production, with authors like Ilyas (13 articles) and Sapuan (10) at the forefront. Approximately 41.7 % of the studies used corn starch. The analysis revealed that 66 % of the studies investigated films with cellulose nanofibrils (CNF), 32 % with cellulose nanocrystals (CNC), and 2 % with bacterial nanocellulose (CB). The majority of studies (94.1 %) used the casting method for film production. Additionally, 35.44 % focused on reinforcing films with nanocellulose, while 7 % developed blends with other biopolymers. About 59.44 % examined the performance of starch films for food packaging, 11.25 % explored practical applications in various foods. Furthermore, 7.94 % incorporated active agents to improve antioxidant and antimicrobial properties, 1.30 % investigated active packaging. Moreover, 2.36 % explored the use of films in materials engineering, and 2.36 % explored biomedical potential. Only 0.40 % evaluated the impact of films on wastewater treatment. The analysis highlights the potential of starch films with nanocellulose, demonstrating their diverse applications and the growing interest in the field.