Comprehensive Characterization of the General Surgery Residency Learning Environment and the Association With Resident Burnout.

OBJECTIVES: To characterize the learning environment (ie, workload, program efficiency, social support, organizational culture, meaning in work, and mistreatment) and evaluate associations with burnout in general surgery residents. BACKGROUND SUMMARY DATA: Burnout remains high among general surgery residents and has been linked to workplace exposures such as workload, discrimination, abuse, and harassment. Associations between other measures of the learning environment are poorly understood. METHODS: Following the 2019 American Board of Surgery In-Training Examination, a cross-sectional survey was administered to all US general surgery residents. The learning environment was characterized using an adapted Areas of Worklife survey instrument, and burnout was measured using an abbreviated Maslach Burnout Inventory. Associations between burnout and measures of the learning environment were assessed using multivariable logistic regression. RESULTS: Analysis included 5277 general surgery residents at 301 programs (85.6% response rate). Residents reported dissatisfaction with workload (n = 784, 14.9%), program efficiency and resources (n = 1392, 26.4%), social support and community (n = 1250, 23.7%), organizational culture and values (n = 853, 16.2%), meaning in work (n = 1253, 23.7%), and workplace mistreatment (n = 2661, 50.4%). The overall burnout rate was 43.0%, and residents were more likely to report burnout if they also identified problems with residency workload [adjusted odds ratio (aOR) 1.60, 95% confidence interval (CI) 1.31-1.94], efficiency (aOR 1.74; 95% CI 1.49-2.03), social support (aOR 1.37, 95% CI 1.15-1.64), organizational culture (aOR 1.64; 95% CI 1.39-1.93), meaning in work (aOR 1.87; 95% CI 1.56-2.25), or experienced workplace mistreatment (aOR 2.49; 95% CI 2.13-2.90). Substantial program-level variation was observed for all measures of the learning environment. CONCLUSIONS: Resident burnout is independently associated with multiple aspects of the learning environment, including workload, social support, meaning in work, and mistreatment. Efforts to help programs identify and address weaknesses in a targeted fashion may improve trainee burnout.

A Role for cAMP and Protein Kinase A in Experimental Necrotizing Enterocolitis.

Necrotizing enterocolitis (NEC) is a devastating intestinal disease that has been associated with Cronobacter sakazakii and typically affects premature infants. Although NEC has been actively investigated, little is known about the mechanisms underlying the pathophysiology of epithelial injury and intestinal barrier damage. Cyclic adenosine monophosphate (cAMP) and protein kinase A (PKA) are important mediators and regulators of apoptosis. To test the hypothesis that C. sakazakii increases cAMP and PKA activation in experimental NEC resulting in increased epithelial apoptosis, we investigated the effects of C. sakazakii on cAMP and PKA in vitro and in vivo. Specifically, rat intestinal epithelial cells and a human intestinal epithelial cell line were infected with C. sakazakii, and cAMP levels and phosphorylation of PKA were measured. An increase in cAMP was demonstrated after infection, as well as an increase in phosphorylated PKA. Similarly, increased intestinal cAMP and PKA phosphorylation were demonstrated in a rat pup model of NEC. These increases were correlated with increased intestinal epithelial apoptosis. The additional of a PKA inhibitor (KT5720) significantly ameliorated these effects and decreased the severity of experimental NEC. Findings were compared with results from human tissue samples. Collectively, these observations indicate that cAMP and PKA phosphorylation are associated with increased apoptosis in NEC and that inhibition of PKA activation protects against apoptosis and experimental NEC.

Evaluation of quality, readability, suitability, and usefulness of online resources available to cancer survivors.

PURPOSE: The aim of this study was to evaluate the quality, readability, suitability, and usefulness of resources publicly available to adult cancer survivors (aged 18 +) who have completed primary treatment. METHODS: Resources were identified in July 2021 through Google. Search completeness was verified using Yahoo, Bing, and MedlinePlus. Retrieved resources were assessed for quality using the DISCERN, readability, suitability using the Suitability Assessment Measure (SAM), and usefulness based on a list of unmet needs and self-management skills derived from the literature. Descriptive analyses were conducted, and a cluster analysis identified the highest-scoring resources. RESULTS: Forty-five resources were included. The mean DISCERN score was fair at 63.3% (SD 13.7%) with low-rated items being sources, publication date, and risks and mechanisms of treatment. The mean reading grade level was 11.19 (SD 1.61, range 8-16) with only one resource scoring an 8. The mean SAM score was in the adequate range at 48.2% (SD 10.6%), with graphics being the lowest-rated section. On average, included resources addressed 57.7% (SD 27.3%) of the unmet needs and 48.4% (SD 20.9%) of the self-management skills, the least addressed being problem-solving. CONCLUSION: Quality and suitability were fair, whereas readability exceeded recommended levels. Only one resource had a superior score in both quality and suitability. IMPLICATIONS FOR CANCER SURVIVORS: The most pressing need is to develop resources for cancer survivors that address their unmet needs and are accessible in terms of literacy. Study findings outline the highest-scoring resources currently available to survivors, families, and clinicians.

An evaluation of the suitability, readability, quality, and usefulness of online resources for patients with cancer receiving immunotherapy.

OBJECTIVE: To evaluate the suitability, readability, quality, and usefulness of available online resources about the side effects of immunotherapy. METHODS: Resources were identified through online searches (Google, Microsoft Bing, and Yahoo search engines) and evaluated using the Suitability Assessment Materials (SAM), three readability formulae, the DISCERN tool (quality), and a checklist of symptom management strategies and self-management skills (usefulness). Hierarchical cluster analysis identified resources scoring highly for suitability and quality. Factors associated with the clusters were identified using Fischer's exact tests. RESULTS: The 51 resources retained for evaluation were of low suitability and quality and exceeded recommended reading levels. Resources were lacking key features to support learning (e.g., illustrations) as well as information about the risks of treatments and the effect of treatments on quality of life. Few resources addressed key self-management skills of problem-solving and taking action. The cluster analysis identified "low" and "moderate" clusters for suitability and quality, and pamphlets and booklets were more likely to be in the moderate cluster as compared to webpages. CONCLUSION: There is a lack of high-quality resources to support patients' learning to self-manage side effects of immunotherapy. PRACTICE IMPLICATIONS: Results identify the best available online resources for self-managing side effects of immunotherapy and gaps for future work. Based on findings, a template for patient education materials was developed.

Evaluation of the healing properties of Garcinia brasiliensis extracts in a cutaneous wound model.

ETHNOPHARMACOLOGICAL RELEVANCE: Wound healing is a complex process that can leave pathological scars, especially in case of infections from opportunistic microorganisms. In this context, herbal medicines open up great possibilities for investigation. One of the species of interest native to Brazil is Garcinia brasiliensis ("bacupari"). Traditionally known for treating wounds and ulcers, G. brasiliensis presents anti-inflammatory, antioxidant and antimicrobials properties. But, its wound healing profile in experimental models, in order to validate its efficacy, is still litle studied. AIM OF THE STUDY: Thus, the objective of this work was to evaluate, in an infected cutanous wound model, the potential of formulations incorporated with G. brasiliensis leaves extracts. MATERIALS AND METHODS: Crude extract (CE), Ethyl Acetate Fraction (EAF) and Hexanic Fraction (HF) were submitted to phytochemical assays, high performance thin layer chromatography (HTPLC) and cytotoxicity studies. CE and EAF were also tested for microbicidal properties and incorporated in cream and gel formulations at 10% concentration. After stability testing, the gel formulations with CE or EAF at 10% were selected and applied to skin wounds infected or not with Staphylococcus aureus in Wistar rats. The healing potenttial of the extracts was verified by the expression of the protein Annexin A1 (AnxA1), related to the processes of inflammation and antifibrotic function, the cells immunostaining for Gasdermin-D (GSDM-D), a marker of pyroptotic cell death, and the dosage of interleukin-10 (IL-10) and monocyte chemotactic protein (MCP)-1 inflammatory mediators. RESULTS: Phytochemical studies indicated the presence of compounds of pharmacological interest, including Catechin, Quercetin and Berberine in addition to low cytotoxicity of CE and EAF at 10%. After the 6-day topical treatments, CE and EAF gel formulations demonstrated to control the pruritus formation process. The treatments decreased AnxA1 expression and the amount of cells immunostained for GSDM-D, and increased the expression of MCP-1 in infected wounds. CONCLUSIONS: Together, the results show important anti-inflammatory profile and skin healing potential of CE and EAF from G. brasiliensis leaves, even in infected lesions, with therapeutic perspectives.

Allergy and immunotherapy: are they related to migraine headache?

INTRODUCTION: Several studies have reported that migraine headaches are more common in patients with allergic rhinitis and that immunotherapy decreases the frequency of headache in atopic headache sufferers. OBJECTIVE: To determine if the degree of allergic sensitization and the administration of immunotherapy are associated with the prevalence, frequency, and disability of migraine headache in patients with allergic rhinitis. METHODS: Consecutive patients between the ages of 18-65 presenting to an allergy practice that received a diagnosis of an allergic rhinitis subtype (eg, allergic or mixed rhinitis) were enrolled in this study. All participants underwent allergy testing as well as a structured verbal headache diagnostic interview to ascertain the clinical characteristics of each headache type. Those reporting headaches were later assigned a headache diagnosis by a headache specialist blinded to the rhinitis diagnosis based on 2004 International Classification Headache Disorders-2 (ICHD-2) diagnostic criteria. Migraine prevalence was defined as the percentage of patients with a diagnosis of migraine headache (ICHD-2 diagnoses 1.1-1.5). Migraine frequency represented the number of days per month with migraine headache self-reported during the headache interview and migraine disability was the number of days with disability obtained from the Migraine Disability Assessment questionnaire. Generalized linear models were used to analyze the migraine prevalence, frequency, and disability with the degree of allergic sensitization (percentage of positive allergy tests) and administration of immunotherapy as covariates. Patients were categorized into high (> 45% positive allergy tests) and low (≤ 45% positive allergy tests) atopic groups based on the number of allergy tests that were positive for the frequency and disability analyses. RESULTS: A total of 536 patients (60% female, mean age 40.9 years) participated in the study. The prevalence of migraine was not associated with the degree of allergic sensitization, but there was a significant age/immunotherapy interaction (P < .02). Migraine headaches were less prevalent in the immunotherapy group than the nonimmunotherapy at ages < 40 years and more prevalent in the immunotherapy group at ages ≥ 40 years of age. In subjects ≤ 45 years of age, increasing percentages of allergic sensitization were associated with a decreased frequency and disability of migraine headache in the low atopic group (risk ratios [RRs] of 0.80 [95% CI; 0.65, 0.99] and 0.81[95% CI; 0.68, 0.97]) while increasing percentages were associated with an increased frequency (not disability) in the high atopic group (RR = 1.60; [95% CI; 1.11, 2.29]). In subjects ≤ 45 years of age, immunotherapy was associated with decreased migraine frequency and disability (RRs of 0.48 [95% CI; 0.28, 0.83] and 0.55 [95% CI; 0.35, 0.87]). In those > 45 years of age, there was no effect of degree of allergic sensitization or immunotherapy on the frequency and disability of migraine headache. CONCLUSIONS: Our study suggests that the association of allergy with migraine headaches depends upon age, degree of allergic sensitization, administration of immunotherapy, and the type of headache outcome measure that are studied. Lower "degrees of atopy" are associated with less frequent and disabling migraine headaches in younger subjects while higher degrees were associated with more frequent migraines. The administration of immunotherapy is associated with a decreased prevalence, frequency, and disability of migraine headache in younger subjects.

Hydrothermal carbonization of simulated food waste for recovery of fatty acids and nutrients.

We conducted Hydrothermal carbonization (HTC) of simulated food waste under different reaction conditions (180 to 220 °C, 15 and 30 min), with the aim of recovering both fatty acids from the hydrochar and nutrients from the aqueous-phase products. HTC of the simulated food waste produced hydrochar that retained up to 78% of the original fatty acids. These retained fatty acids were extracted from the hydrochar using ethanol, a food-grade solvent, and gave a net recovery of fatty acid of âˆ¼ 50%. The HTC process partitioned more than 50 wt% of the phosphorus and around 38 wt% of the nitrogen into the aqueous-phase products. A reaction path consistent with decarboxylation predominated during HTC under all of the reaction conditions investigated. A path consistent with dehydration was also observed, but only for the more severe reaction conditions. This work illustrates the potential that HTC has for valorization of food waste.

The role of surgical experience in patient selection, surgical quality, and outcomes in robot-assisted radical cystectomy.

BACKGROUND: Robot-assisted radical cystectomy (RARC) remains one of the most complex urological procedures. Due to regionalization of bladder cancer care, there is likely an imbalance in experience among urologists performing RARC. We sought to describe changes in patient selection, surgical quality surrogates and rates of complications in relation to surgical experience. METHODS: We retrospectively reviewed 409 consecutive patients with bladder cancer who underwent RARC between 2006 and 2017 by a single surgeon. The cohort was divided into 4 quartiles (Q1-Q4) according to surgical experience, based on the chronologic order at which RARC was performed. Baseline, perioperative and pathologic characteristics of patients were compared among the 4 groups. 30-day and 90-day complications were assessed using the Clavien-Dindo system. The association between surgical experience (quartile) and complications was assessed using multivariable logistic regression analyses. RESULTS: Median age (interquartile range [IQR] from 70-73 years), body mass index (IQR from 25 to 27 kg/m2) and preoperative glomerular filtration rate (IQR from 59 to 65 ml/min) were similar among all quartiles (all P > 0.05). Patients in Q4 had higher rates of previous abdominopelvic surgery (46.1% vs. 30.4%, P = 0.031) and American Society of Anesthesiologists score of 3 to 4 (72.3% vs. 47.1%, P = 0.003) compared to patients in Q1. Patients who underwent RARC in Q4 compared to Q1, had less estimated blood loss (250 ml vs. 350 ml, P < 0.001), shorter operative time (346 vs. 360 minutes, P < 0.001), and higher lymph node yield (22 vs. 17 nodes, P < 0.001). The 30-day and 90-day complication rates were 53% and 62%, respectively. Thirty-day complication rates were similar among all 4 quartiles (P > 0.05), but higher among patients in Q4 compared to Q1 within 90 days (74% vs. 54%, P = 0.01). On multivariable analysis, patients in Q4 were more likely to experience any 90-day complication (OR 2.03, 95%Cl 1.11-3.70) compared to Q1. CONCLUSION: Our results show that with surgical experience, more complex cases can be performed while continuing to improve surgical quality. Nonetheless, there appears to be a trade-off between the increase in complexity of cases performed with experience and accepting higher rates of complications.

Constructing Learning Curves to Benchmark Operative Performance of General Surgery Residents Against a National Cohort of Peers.

OBJECTIVE: No method or data exist to allow surgical trainees or their programs to contextualize their technical progress. The objective of this study was to create peer benchmarks for Cumulative Sum (CUSUM) charts based upon operative evaluations from a national cohort of general surgery residents. DESIGN, SETTING, PARTICIPANTS: In 2016-2018, faculty from 26 general surgery residency programs nationwide rated 328 residents' operative performance on a case-by-case basis using a validated 5-point Likert scale. An individual case was considered a "misstep" if scoring below the national median score for that procedure in that postgraduate year (PGY). We constructed 2-sided observed-expected CUSUM charts to capture each resident's cumulative performance over time relative to the national medians. Upper (failure) and lower (positive outlier) benchmarks were established based on the PGY-specific 75th percentile and median misstep rates; consistent/repeated missteps are reflected by crossing of the upper boundary. Procedures with ≤10 observations and residents who were evaluated <10 times for each PGY were excluded. RESULTS: Around 8,161 evaluations on 76 procedure types were analyzed. The individual misstep rate was lowest among PGY-3s at 13.3% and highest among PGY-4s at 28.6%. No interns had curves that crossed the failure boundary. 8.7% of PGY-2s and 8.9% of PGY-3s finished the year past the failure boundary. PGY-2s had the most positive outliers, with 28.3% of them demonstrating an outlying success performance beyond the lower boundary for at least once. PGY-5s most frequently failed, with 16.7% ever crossing the upper boundary and 11.1% remaining above it at graduation. CONCLUSIONS: CUSUM is a valid statistical approach for benchmarking individual residents' operative performance against national peers as they progress through the year in real-time. With further validation, CUSUM could be used to set progression and/or graduation standards and objectively identify residents who might benefit from remediation.

Ambulatory Bladder Cancer Care in the United States.

INTRODUCTION: Contemporary data on bladder cancer care in the United States are lacking. We used nationally representative data to characterize outpatient bladder cancer care in the U.S. and identify potential areas for quality improvement. METHODS: The NAMCS (National Ambulatory Medical Care Survey), conducted annually by the Centers for Disease Control and Prevention, is designed to generate weighted estimates of national ambulatory care practice patterns. We evaluated NAMCS data from 2001 to 2014 to characterize patient, physician and visit characteristics associated with a diagnosis of bladder cancer. RESULTS: During the 14-year study period there were 7,410,240 weighted visits to a urologist for a diagnosis of bladder cancer. The total number of urology visits for bladder cancer significantly increased during the study period (p=0.03). Overall 35% of patients with bladder cancer saw their urologist 6 or more times annually. Mean visit duration was 21.8 minutes. Mean age of patients with a bladder cancer diagnosis was 71.3 years. Men and women accounted for 8,106,756 and 3,052,690 visits, respectively (p <0.01). Medicare coverage represented the largest payer system (60.7%). Urologists provided smoking cessation counseling to only 21.2% of current smokers and nutrition counseling was provided for just 14.7% of all obese patients with bladder cancer. CONCLUSIONS: Bladder cancer visits account for more than half a million ambulatory urology visits annually. Routine lifestyle interventions such as smoking cessation and nutrition counseling should be implemented during urology visits to further improve the care of patients with bladder cancer.

Gynecologic Organ Involvement During Radical Cystectomy for Bladder Cancer: Is It Time to Routinely Spare the Ovaries?

PURPOSE: To determine a subset of women who could undergo ovary-sparing radical cystectomy (OSRC) for bladder cancer without compromising oncologic safety. PATIENTS AND METHODS: A retrospective review was performed of 164 consecutive women who underwent cystectomy at a single tertiary-care center from 1997 to 2018. Clinicopathologic and preoperative radiographic data were reviewed. Univariable and multivariable logistic regression models adjusting for pathologic stage, lymphovascular invasion (LVI), and carcinomain-situ were performed to evaluate the risk of ovarian and reproductive organ (RO) involvement. RESULTS: A total of 123 women with a median age of 71 years underwent radical cystectomy (RC) with removal of ROs for primary bladder cancer. Nineteen women (15%) had RO involvement by bladder cancer, and 5 of them (4%) were specifically found to have ovarian involvement. Patients with ovarian involvement of bladder cancer had more locally advanced disease (P = .01), LVI (P = .003) and positive margins (P = .003). On multivariable logistic regression, ≥ pT3 (odds ratio = 10.2; 95% confidence interval, 2.0-51.6; P = .005) and LVI (odds ratio = 3.9; 95% confidence interval, 1.1-14.2; P = .037) were associated with increased risk of RO involvement. Among 15 patients excluded for having a nonbladder primary malignancy, a third had RO involvement, and 2 (13%) had ovarian metastases. No women in our cohort had a primary ovarian malignancy detected at the time of RC. CONCLUSION: Women with ovarian involvement by malignancy at the time of RC either had locally advanced disease with LVI or a non-bladder primary malignancy. The risk of incompletely resecting the primary malignancy would be rare if OSRC was performed on women with organ-confined (≤T2) urothelial carcinoma.

Deficiências visuais: incidência e sua relação regional e escolar em um município no noroeste paulista / Visual disabilities: incidence and its regional and school relationship in a municipality in northwest paulista

Introdução: Baixa acuidade visual é um problema de alta prevalência, podendo atingir até 25% das crianças em idade escolar e dentre os principais problemas estão a miopia, a hipermetropia, o astigmatismo, a ambliopia, o estrabismo e o daltonismo. Objetivo: O estudo visa determinar a prevalência de deficiências visuais não diagnosticadas em crianças de quatro e cinco anos que frequentam escolas em um município no noroeste paulista, relacionando-a ao sexo e a característica de escola (pública ou privada). Material e Método: Estudo observacional transversal prospectivo quantitativo, realizado em duas escolas públicas e duas privadas, localizadas no munícipio de Catanduva, São Paulo, Brasil, onde se aplicaram testes realizados para possíveis diagnósticos de distúrbios de acuidade visual (Teste de Snellen), Daltonismo (Teste de Ishihara) e Estrabismo (Teste de Hirschberg). Resultados: Foram avaliadas 245 crianças. Para a análise estatística, foram utilizados os testes qui-quadrado de Pearson e exato de Fisher. A prevalência de baixa acuidade visual foi de 29,73% nas escolas particulares, 43,27% nas públicas (p=0,046); no que se refere a sexo, 20,57% dos meninos apresentaram baixa acuidade visual, contra 17,31% das meninas (p=0,52). O Teste de Hirschberg apresentouse alterado em 24,32% dos alunos de escola particular, 17,54% dos de escola pública (p=0,22), 18,44% dos meninos e 21,15% das meninas (p=0,6). Já, alterações no teste de Ishihara manifestaram-se em 5,41% dos alunos das escolas privadas e 4,09% dos de escola pública (p=0,65); 6,38% e 1,92% dos meninos e meninas, respectivamente, apresentaram alterações (p=0,1). Destaca-se a importância do acompanhamento com um oftalmologista desde a infância, visto que a prevalência de deficiências visuais não diagnosticadas permanece significativa, principalmente quanto aos distúrbios de acuidade visual nas escolas públicas. Conclusão: O diagnóstico precoce de deficiência visual é primordial, pois muitas alterações são reversíveis por apenas um curto período

Introduction: Low visual acuity is a highly prevalent problem, affecting up to 25% of school-age children and the main problems include myopia, hyperopia, astigmatism, amblyopia, strabismus and color blindness. Objective: The study aims to determine the prevalence of undiagnosed visual impairments in children aged four and five who attend schools in a city in the northwest of São Paulo, relating it to gender and the characteristics of the school (public or private). Material and Method: Quantitative prospective cross-sectional observational study, carried out in two public and two private schools, located in the municipality of Catanduva, São Paulo, Brazil, where tests were applied, carried out for possible diagnoses of visual acuity disorders (Snellen Test), Color blindness (Ishihara Test) and Strabismus (Hirschberg Test). Results: 245 children were evaluated. For statistical analysis, Pearson's chi-square and Fisher's exact tests were used. The prevalence of low visual acuity was 29.73% in private schools, 43.27% in public schools (p=0.046); Regarding gender, 20.57% of boys had low visual acuity, compared to 17.31% of girls (p=0.52). The Hirschberg Test was altered in 24.32% of private school students, 17.54% of public school students (p=0.22), 18.44% of boys and 21.15% of girls (p =0.6). Changes in the Ishihara test were manifested in 5.41% of students in private schools and 4.09% of those in public schools (p=0.65); 6.38% and 1.92% of boys and girls, respectively, showed changes (p=0.1). The importance of monitoring with an ophthalmologist since childhood is highlighted, as the prevalence of undiagnosed visual impairments remains significant, especially regarding visual acuity disorders in public schools. Conclusion: Early diagnosis of visual impairment is essential, as many changes are reversible for only a short period

Introducción: La baja agudeza visual es un problema altamente prevalente, afecta hasta al 25% de los niños en edad escolar y los principales problemas incluyen miopía, hipermetropía, astigmatismo, ambliopía, estrabismo y daltonismo. Objetivo: El estudio tiene como objetivo determinar la prevalencia de discapacidad visual no diagnosticada en niños de cuatro y cinco años que asisten a escuelas de una ciudad del noroeste de São Paulo, relacionándola con el género y las características de la escuela (pública o privada). Material y Método: Estudio observacional cuantitativo, prospectivo, transversal, realizado en dos escuelas públicas y dos privadas, ubicadas en el municipio de Catanduva, São Paulo, Brasil, donde se aplicaron pruebas realizadas para posibles diagnósticos de trastornos de la agudeza visual (Snellen Test), daltonismo (test de Ishihara) y estrabismo (test de Hirschberg). Resultados: Se evaluaron 245 niños. Para el análisis estadístico se utilizaron las pruebas de chi-cuadrado de Pearson y exacta de Fisher. La prevalencia de baja agudeza visual fue de 29,73% en colegios privados, 43,27% en públicos (p=0,046); En cuanto al género, el 20,57% de los niños presentó baja agudeza visual, frente al 17,31% de las niñas (p=0,52). El Test de Hirschberg se vio alterado en el 24,32% de los estudiantes de escuelas privadas, el 17,54% de los estudiantes de escuelas públicas (p=0,22), el 18,44% de los niños y el 21,15% de las niñas (p =0,6). Los cambios en la prueba de Ishihara se manifestaron en el 5,41% de los estudiantes de escuelas privadas y el 4,09% de los de escuelas públicas (p=0,65); El 6,38% y el 1,92% de niños y niñas, respectivamente, presentaron cambios (p=0,1). Se destaca la importancia del seguimiento con un oftalmólogo desde la infancia, ya que la prevalencia de deficiencias visuales no diagnosticadas sigue siendo significativa, especialmente en lo que respecta a los trastornos de la agudeza visual en las escuelas públicas. Conclusión: El diagnóstico temprano de la discapacidad visual es esencial, ya que muchos cambios son reversibles sólo durante un período corto

Consumo de substâncias psicoativas entre estudantes de medicina antes e depois do ingresso no curso / Use of psychoactive substances among medicine students before and after admission to course

Introdução: Substâncias psicoativas são capazes de alterar a consciência, o humor ou o pensamento de um indivíduo, resultando em mudanças fisiológicas ou de comportamento. Objetivo: Este estudo avaliou se houve diferença no consumo de 13 substâncias psicoativas por estudantes de medicina, de uma faculdade privada do interior paulista, antes e depois do ingresso no curso. Método: Um questionário estruturado e impresso foi apresentado a ingressantes no curso de medicina, em abril de 2019, e, novamente, em dezembro, ao final do primeiro ano da graduação. Resultados: Na análise dos dados, foi realizado o Teste de Wilcoxon, com o emprego do programa estatístico JASP. No total, 90 estudantes participaram do estudo. Dentre as 13 substâncias consideradas, apenas para o álcool foram encontradas evidências estatísticas que indicaram ter ocorrido um aumento significativo no consumo após o ingresso no curso (W = 1308,00, p < 0,001). Conclusão: A continuidade dos estudos sobre o uso de substâncias lícitas e ilícitas entre os estudantes da instituição de ensino considerada será fundamental para garantir um monitoramento contínuo. Desse modo, a instituição poderá identificar usos abusivos e implementar políticas de prevenção, garantindo o bem-estar de seus alunos

Introduction: Psychoactive substances are capable of altering an individual's consciousness, mood or thinking, resulting in physiological or behavioral changes. Objective: This study assessed whether there was a difference in the consumption of 13 psychoactive substances by medical students at a private college in the interior of São Paulo, before and after enrolling in the course. Method: A structured, printed questionnaire was presented to new medicine students in April 2019, and again in December, at the end of the first year of graduation. Results: In data analysis, the Wilcoxon Test was performed, using the JASP statistical program. In total, 90 students participated in the study. Among the 13 substances considered, only for alcohol was statistical evidence found that indicated that there had been a significant increase in consumption after enrolling in the course (W = 1308.00, p < 0.001). Conclusion: Continuing studies on the use of legal and illicit substances among students at the educational institution considered will be essential to ensure continuous monitoring. In this way, the institution will be able to identify abusive uses and implement prevention policies, ensuring the well-being of its students

Introducción: Las sustancias psicoactivas son capaces de alterar la conciencia, el estado de ánimo o el pensamiento de un individuo, resultando en cambios fisiológicos o de comportamiento. Objetivo: Este estudio evaluó si existía diferencia en el consumo de 13 sustancias psicoactivas por estudiantes de medicina de una facultad privada del interior de São Paulo, antes y después de matricularse en el curso. Método: Se presentó un cuestionario impreso estructurado a los nuevos estudiantes de medicina en abril de 2019, y nuevamente en diciembre, al final del primer año de graduación. Resultados: En el análisis de los datos se realizó la Prueba de Wilcoxon, utilizando el programa estadístico JASP. En total, 90 estudiantes participaron en el estudio. Entre las 13 sustancias consideradas, sólo para el alcohol se encontró evidencia estadística que indicaba que había habido un aumento significativo en el consumo después de la inscripción al curso (W = 1308,00, p < 0,001). Conclusión: Continuar con los estudios sobre el uso de sustancias legales e ilícitas entre los estudiantes de la institución educativa considerada será fundamental para garantizar un seguimiento continuo. De esta manera, la institución podrá identificar usos abusivos e implementar políticas de prevención, asegurando el bienestar de sus estudiantes

Probiotic Lactobacillus Species Strengthen Intestinal Barrier Function and Tight Junction Integrity in Experimental Necrotizing Enterocolitis.

Necrotizing enterocolitis (NEC) is a serious intestinal disease that occurs in newborn infants. It is associated with major morbidity and affects 5% of all infants admitted to neonatal intensive care units. Probiotics have variable efficacy in preventing necrotizing enterocolitis. Tight junctions (TJ) are protein complexes that maintain epithelial barrier integrity. We hypothesized that the probiotics Lactobacillus rhamnosus and Lactobacillus plantarum strengthen intestinal barrier function, promote TJ integrity, and protect against experimental NEC. Both an in vitro and an in vivo experimental model of NEC were studied. Cultured human intestinal Caco-2 cells were pretreated with L. rhamnosus and L. plantarum probiotics. TJ were then disrupted by EGTA calcium switch or LPS to mimic NEC in vitro. Trans-epithelial resistance (TER) and flux of fluorescein isothiocynate dextran was measured. TJ structure was evaluated by ZO-1 immunofluorescence. In vivo effects of ingested probiotics on intestinal injury and ZO-1 expression were assessed in a rat model of NEC infected with Cronobacter sakazakii (CS). Caco-2 cells treated with individual probiotics demonstrated higher TER and lower permeability compared to untreated cells (p<0.0001). ZO-1 immunofluorescence confirmed TJ stability in treated cells. Rat pups fed probiotics alone had more intestinal injury compared with controls (p=0.0106). Probiotics were protective against injury when given in combination with CS, with no difference in intestinal injury compared to controls (p=0.21). Increased permeability was observed in the probiotic and CS groups (p=0.03, p=0.05), but not in the probiotic plus CS group (p=0.79). Lactobacillus sp. strengthened intestinal barrier function and preserved TJ integrity in an in vitro experimental model of NEC. In vivo, probiotic bacteria were not beneficial when given alone, but were protective in the presence of CS in a rat model of NEC.

Ovariectomy-Induced Osteoporosis Does Not Impact Fusion Rates in a Recombinant Human Bone Morphogenetic Protein-2-Dependent Rat Posterolateral Arthrodesis Model.

Study Design Randomized, controlled animal study. Objective Recombinant human bone morphogenetic protein-2 (rhBMP-2) is frequently utilized as a bone graft substitute in spinal fusions to overcome the difficult healing environment in patients with osteoporosis. However, the effects of estrogen deficiency and poor bone quality on rhBMP-2 efficacy are unknown. This study sought to determine whether rhBMP-2-induced healing is affected by estrogen deficiency and poor bone quality in a stringent osteoporotic posterolateral spinal fusion model. Methods Aged female Sprague-Dawley rats underwent an ovariectomy (OVX group) or a sham procedure, and the OVX animals were fed a low-calcium, low-phytoestrogen diet. After 12 weeks, the animals underwent a posterolateral spinal fusion with 1 µg rhBMP-2 on an absorbable collagen sponge. Representative animals were sacrificed at 1 week postoperative for alkaline phosphatase (ALP) and osteocalcin serum analyses. The remaining animals underwent radiographs 2 and 4 weeks after surgery and were subsequently euthanized for fusion analysis by manual palpation, micro-computed tomography (CT) imaging, and histologic analysis. Results The ALP and osteocalcin levels were similar between the control and OVX groups. Manual palpation revealed no significant differences in the fusion scores between the control (1.42 ± 0.50) and OVX groups (1.83 ± 0.36; p = 0.07). Fusion rates were 100% in both groups. Micro-CT imaging revealed no significant difference in the quantity of new bone formation, and histologic analysis demonstrated bridging bone across the transverse processes in fused animals from both groups. Conclusions This study demonstrates that estrogen deficiency and compromised bone quality do not negatively influence spinal fusion when utilizing rhBMP-2, and the osteoinductive capacity of the growth factor is not functionally reduced under osteoporotic conditions in the rat. Although osteoporosis is a risk factor for pseudarthrosis/nonunion, rhBMP-2-induced healing was not inhibited in osteoporotic rats.

Urinary Claudin-2 Measurements as a Predictor of Necrotizing Enterocolitis: A Pilot Study.

BACKGROUND: Necrotizing Enterocolitis (NEC) affects 5-10% of NICU patients where initially patients may have only nonspecific clinical findings. A noninvasive tool for detection would aid in diagnosis. Increased urinary claudins have been associated with active adult inflammatory bowel disease. METHODS: Institutional Review Board approval was obtained. Neonatal intestinal tissue samples were obtained from patients with and without NEC. Immunofluorescence analysis of claudin-2 was performed on the intestinal tissue. Thirty two urine samples were collected from 6 NICU patients. Proteins were extracted and urinary claudin-2 expression was measured using Western Blot Analysis. All sample concentrations were normalized to urinary creatinine. Differences were analyzed with ANOVA or Student's T-test. Findings were correlated to the patient's clinical status. RESULTS: Neonatal intestinal immunofluorescence analysis revealed that claudin-2 is present in healthy intestinal epithelium and is decreased in NEC intestinal tissue (p=0.0001). Of the six patients evaluated, three patients had NEC. All 3 patients with NEC had spikes in urinary claudin-2 levels (p<0.001, p<0.001, p 0.0598 respectively). Spikes did not appear to correlate with other etiologies of neonatal sepsis, medication use or need for mechanical ventilation. Levels during active NEC were almost twice that of NEC-free periods (p<0.0001). CONCLUSION: A tool for early detection would facilitate early intervention and potential prevention of severe NEC. Preliminary findings indicate that urinary claudin-2 may represent a potential biomarker for NEC worth further investigation.

Gel scaffolds of BMP-2-binding peptide amphiphile nanofibers for spinal arthrodesis.

Peptide amphiphile (PA) nanofibers formed by self-assembly can be customized for specific applications in regenerative medicine through the use of molecules that display bioactive signals on their surfaces. Here, the use of PA nanofibers with binding affinity for the bone promoting growth factor BMP-2 to create a gel scaffold for osteogenesis is reported. With the objective of reducing the amount of BMP-2 used clinically for successful arthrodesis in the spine, amounts of growth factor incorporated in the scaffolds that are 10 to 100 times lower than that those used clinically in collagen scaffolds are used. The efficacy of the bioactive PA system to promote BMP-2-induced osteogenesis in vivo is investigated in a rat posterolateral lumbar intertransverse spinal fusion model. PA nanofiber gels displaying BMP-2-binding segments exhibit superior spinal fusion rates relative to controls, effectively decreasing the required therapeutic dose of BMP-2 by 10-fold. Interestingly, a 42% fusion rate is observed for gels containing the bioactive nanofibers without the use of exogenous BMP-2, suggesting the ability of the nanofiber to recruit endogenous growth factor. Results obtained here demonstrate that bioactive biomaterials with capacity to bind specific growth factors by design are great targets for regenerative medicine.