Plasma Metabolome Signatures to Predict Responsiveness to Neoadjuvant Chemotherapy in Breast Cancer.

BACKGROUND: Neoadjuvant chemotherapy (NACT) has arisen as a treatment option for breast cancer (BC). However, the response to NACT is still unpredictable and dependent on cancer subtype. Metabolomics is a tool for predicting biomarkers and chemotherapy response. We used plasma to verify metabolomic alterations in BC before NACT, relating to clinical data. METHODS: Liquid chromatography coupled to mass spectrometry (LC-MS) was performed on pre-NACT plasma from patients with BC (n = 75). After data filtering, an SVM model for classification was built and validated with 75%/25% of the data, respectively. RESULTS: The model composed of 19 identified metabolites effectively predicted NACT response for training/validation sets with high sensitivity (95.4%/93.3%), specificity (91.6%/100.0%), and accuracy (94.6%/94.7%). In both sets, the panel correctly classified 95% of resistant and 94% of sensitive females. Most compounds identified by the model were lipids and amino acids and revealed pathway alterations related to chemoresistance. CONCLUSION: We developed a model for predicting patient response to NACT. These metabolite panels allow clinical gain by building precision medicine strategies based on tumor stratification.

A Single-Port, Multiple-Access, Custom-Made Device Used in Laparoscopically Assisted Cryptorchidectomy in Standing Horses-A Preliminary Study.

This study evaluates a new multiport device with single access to the abdominal cavity produced with routine hospital supplies that could be applied to laparoscopically assisted cryptorchidectomy in standing horses. Initially, the new device was evaluated on five cadavers of bovine fetuses (n = 5), placed assisted in a minilaparotomy performed in the flank region. Subsequently, the device was evaluated in four cryptorchid horses treated during the hospital routine. During the evaluation of the new device, the possibilities of exploring the abdominal cavity, inspection, and intra-abdominal manipulation with two Babcock forceps were verified. The possibilities were described, and surgical time data were recorded and analyzed using descriptive statistics. In the cadavers, a wide exploration of the abdominal cavity was possible, with a laparoscopic inspection through the right paralumbar fossa and manipulation of intra-abdominal structures with Babcock forceps inserted by the new device. In cryptorchid horses, laparoscopically assisted cryptorchidectomy with a new device was feasible in two patients, and in the others, it allowed the diagnosis of adhesions and ectopic locations in the inguinal region of testicles retained in the cavity. Therefore, the new device was efficient in exploring the inguinal region of cryptorchid horses in the standing position. The present study is preliminary and can support future studies that aim to improve the developed prototype.

Efeito da fotobiomodulação na reabilitação de pacientes com patologias traumato-ortopédicas: revisão integrativa / Efectos de la fotobiomodulación en la rehabilitación de pacientes con patologías traumatoortopédicas: revisión integrativa / Effects of photobiomodulationin the rehabilitation of patients with traumato-orthopedic pathologies: integrative review

Introdução: Fotobiomodulação corresponde à exposição de tecidos biológicos a baixos níveis de luz vermelha e infravermelha, esta terapia favorece a reabilitação de diferentes tecidos e que pode ser utilizada para a melhora da prática clínica nas diferentes atuações da fisioterapia, como por exemplo, no tratamento dos acometimentos musculoesqueléticos e inflamatórios. Objetivo: Identificar os benefícios da fotobiomodulação empregados na reabilitação de pacientes nas diferentes patologias traumato-ortopédicas. Metodologia:Trata-se de uma revisão integrativa com busca online nas plataformas de dados: Medline e PubMed. Os descritores foram: fotobiomodulação, taumato-ortopedia e reabilitação. As línguas selecionadas foram: Português, Inglês e Espanhol, entre os anos de 2018 a 2022.Resultados:A descrição dos achados nos ensaios clínicos analisados mostra que a terapia de fotobiomodulação apresenta diferentes usos na prática clínica e que seu uso produz efeito analgésico, anti-inflamatório e regenerativo nos distúrbios musculoesqueléticos. Conclusões:De acordo com a revisão dos artigos, pôde-se perceber que a terapia por fotobiomodulação confirma seus benefícios e eficácia, portando, se fazendo positiva na atuação traumato-ortopédica, gerando resultados significativos quando comparada a outros recursos (AU).

Introduction: Photobiomodulationcorresponds to the exposure of biological tissues to low levels of red and infrared light, this therapy favors the rehabilitation of different tissues and can be used to improve clinical practice in different actions of physiotherapy, such as, for example, in the treatment of musculoskeletal and inflammatory disorders. Objective: To identify the benefits of photobiomodulation used in the rehabilitation of patients with different traumato-orthopedic pathologies. Methodology:This is an integrative review with online search on data platforms: Medline and PubMed. The descriptors were: photobiomodulation, thaumato-orthopedics and rehabilitation. The selected languages were: Portuguese, English and Spanish, from 2018 to 2022. Results: The description of the discovers in the analyzed clinical trials shows that photobiomodulation therapy has different uses in clinical practice and that its use produces analgesic, anti-inflammatory and regenerative effects in musculoskeletal disorders. Conclusions:According to the review of the articles, it could be seen that photobiomodulation therapy confirms its benefits and effectiveness, therefore, becoming positive in the trauma-orthopedic performance, generating significant results when compared to other resources (AU).

Introducción: La fotobiomodulacióncorresponde a la exposición de tejidos biológicos a bajos niveles de luz roja e infrarroja, esta terapia estimula la rehabilitación de diferentes tejidos y puede ser utilizada para mejorar la práctica clínica en diferentes áreas de fisioterapia, como por ejemplo, en tratamiento de Trastornos musculoesqueléticos e inflamatorios. Objetivo: Identificar los beneficios de la fotobiomodulación utilizada en la rehabilitación de pacientes con diferentes patologías traumato-ortopédicas. Metodología: Esta es una revisión integradora con búsqueda en línea en plataformas de datos: Medline y PubMed. Los descriptores fueron: fotobiomodulación, taumato-ortopedia y rehabilitación. Los idiomas seleccionados fueron: portugués, inglés y español, entre los años 2018 a 2022. Resultados: La descripción de los hallazgos en los ensayos clínicos analizados muestra que la terapia de fotobiomodulación tiene diferentes usos en la práctica clínica y que su uso produce efectos analgésicos, antiinflamatorios y regenerador en trastornos musculoesqueléticos. Conclusiones: De acuerdo con la revisión de los artículos, se pudo apreciar que la terapia de fotobiomodulación confirma sus beneficios y efectividad, por lo tanto, tornándose positiva en el desempeño trauma-ortopédico, generando resultados significativos cuando se compara con otros recursos (AU).

Resultado da mobilização precoce sobre as repercussões clínicas e funcionais de cirurgias torácicas: revisão integrativa / Resultados de la temprana movilización sobre las repercusiones clínicas y funcionales de cirugíatorácica: revisión integrativa / Results of early mobilization on the clinical and functional repercussions of patients submitted to thoracic surgery: integrative review

Introdução: O período de internação os pacientes passam por um longo período de imobilização no leito, acompanhada de complicações e comorbidades que podem ocorrer no período pós-operatório. A fisioterapia aturará prevenindo os efeitos da imobilidade no leito, além de melhorar a independência funcional do paciente. Objetivo: Diante o exposto, o objetivo desse estudo é analisar as repercussões clínicas e funcionais da reabilitação precoce em pacientes submetidos à cirurgia torácica. Metodologia: Trata-se de uma revisão integrativa. Critérios de inclusão: ensaios clínicos randomizados, artigos completos, dos idiomas português, inglês e espanhol, publicados entre 2012 e 2022. Critérios de exclusão: protocolos de ensaios, ensaios não finalizados, estudos inferiores ao ano de 2012 e outras línguas. Descritores: Cirurgia torácica; Deambulação precoce; Modalidades de Fisioterapia. Com seus respectivos termos na língua inglesa. Resultados: Foram encontrados 51 artigos. Com os critérios estabelecidos foram selecionados 06 artigos. Os estudos dos autores avaliados se mostraram benéficos para a terapia de deambulação precoce combinada e exercícios. Conclusões: Os achados resultam na minimização das alterações de fluxo e volume pulmonar, otimização da mecânica do movimento tóraco-abdominal e aumento da amplitude do movimento dos músculos respiratórios, facilitando a reexpansão pulmonar e melhorando osparâmetros de função pulmonar (AU)>

Introduction: During hospitalization, patients go through a long period of immobilization in bed, accompanied by complications and comorbidities that may occur in the postoperative period. Physical therapy will help prevent the effects of immobility in bed, in addition to improving the patient's functional independence. Objective:Given the above, the objective of this study is to analyze the clinical and functional repercussions of early rehabilitation in patients undergoing thoracic surgery. Methodology:It is a systematic review. Inclusion criteria: randomized clinical trials, complete articles, in Portuguese, English and Spanish, published between 2012 and 2022. Exclusion criteria: trial protocols, unfinished trials, studies smaller than 2012 in other languages. Descriptors: Thoracic surgery; Early ambulation; Physiotherapy modalities. Results:51 articles were found. With the established criteria, 06 articles were selected. The evaluated authors' studies have shown benefit for combined early ambulation therapy and exercise. Conclusions:The findings result in the minimization of changes in lung flow and volume, optimization of the mechanics of thoracoabdominal movement and increased range of motion of the respiratory muscles, facilitating lung re-expansion and improving lung function parameters (AU).

Introducción: A lo largo de la hospitalización, los pacientes pasan por un largo período de inmovilización en cama, acompañado de complicacionesy comorbilidades que pueden presentarse en el postoperatorio. La fisioterapia ayudará a prevenir los efectos de la inmovilidad en cama, además de mejorar la independencia funcional del paciente. Objetivo:Teniendo en cuenta lo anterior, el objetivo de este estudio es analizar las repercusiones clínicas y funcionales de la rehabilitación temprana en pacientes sometidos a cirugía torácica.Metodología: Esta es una revisión sistemática. Criterios de inclusión: ensayos clínicos aleatorizados, artículos completos, en portugués, inglés y español, publicados entre 2012 y 2022. Criterios de exclusión: protocolos de ensayos, ensayos inconclusos, estudios menores a 2012 y otros idiomas. Descriptores: Cirugía torácica; Deambulación temprana; Modalidades de fisioterapia. Con sus respectivos términosen inglés.Resultados: Se encontraron 51 artículos. Fueron seleccionados 06 artículos, con los criterios establecidos. Los estudios de los autores evaluados han demostrado beneficios para la combinación de terapia de deambulación temprana y ejercicio.Conclusiones: Los hallazgos resultan en la minimización de alteraciones en el flujo y volumen pulmonar, optimización de la mecánica del movimiento toracoabdominal y aumento en el rango de movimiento de los músculos respiratorios, facilitando la reexpansión pulmonar y mejorando los parámetrosde la función pulmonar (AU).

Correlación entre tiempo en rango y hemoglobina glicosilada en personas con diabetes mellitus: revisión sistemática / Correlation between time on target and glycated hemoglobin in people with diabetes mellitus: systematic review / Correlação entre tempo no alvo e hemoglobina glicada de pessoas com diabetes mellitus: revisão sistemática

Objetivo: analizar la correlación entre el tiempo en rango y la hemoglobina glicosilada de personas que viven con diabetes mellitus y realizan la monitorización continua de la glucemia o el automonitoreo de la glucemia capilar Método: revisión sistemática de etiología y riesgo basada en las directrices del JBI e informada según los Preferred Reporting Items for Systematic Reviews and Meta-Analyses, abarcando seis bases de datos y la literatura gris. La muestra incluyó 16 estudios y la calidad metodológica fue evaluada utilizando las herramientas del JBI. Protocolo registrado en Open Science Framework, disponible en https://doi.org/10.17605/OSF.IO/NKMZB. Resultados: tiempo en rango (70-180 mg/dl) mostró una correlación negativa con la hemoglobina glicosilada, mientras que el tiempo por encima del rango (>180 mg/dl) mostró una correlación positiva. Los coeficientes de correlación variaron entre -0,310 y -0,869 para el tiempo en rango, y entre 0,66 y 0,934 para el tiempo por encima del rango. Un estudio se realizó en una población que hacía el automonitoreo. Conclusión: hay una correlación estadísticamente significativa entre el tiempo en rango y el tiempo por encima del rango con la hemoglobina glicosilada. Cuanto mayor sea la proporción en el rango glucémico adecuado, más cerca o por debajo del 7% estará la hemoglobina glicosilada. Se necesitan más estudios que evalúen esta métrica con datos del automonitoreo de la glucemia.

Objective: to analyze the correlation between time on target and glycated hemoglobin in people living with diabetes mellitus and carrying out continuous blood glucose monitoring or self-monitoring of capillary blood glucose. Method: systematic review of etiology and risk based on JBI guidelines and reported according to Preferred Reporting Items for Systematic Reviews and Meta- Analyses, covering six databases and grey literature. The sample included 16 studies and methodological quality was assessed using JBI tools. Protocol registered in the Open Science Framework, available at https://doi.org/10.17605/OSF.IO/NKMZB. Results: time on target (70-180 mg/dl) showed a negative correlation with glycated hemoglobin, while time above target (>180 mg/dl) showed a positive correlation. Correlation coefficients ranged between -0.310 and -0.869 for time on target, and between 0.66 and 0.934 for time above target. A study was carried out on a population that performed self-monitoring. Conclusion: there is a statistically significant correlation between time on target and time above target with glycated hemoglobin. The higher the proportion in the adequate glycemic range, the closer to or less than 7% the glycated hemoglobin will be. More studies are needed to evaluate this metric with data from self-monitoring of blood glucose.

Objetivo: analisar a correlação entre o tempo no alvo e a hemoglobina glicada de pessoas que vivem com diabetes mellitus e realizam a monitorização contínua da glicemia ou a automonitorização da glicemia capilar. Método: revisão sistemática de etiologia e de risco pautada nas diretrizes do JBI e reportada conforme Preferred Reporting Items for Systematic Reviews and Meta-Analyses, abrangendo seis bases de dados e a literatura cinzenta. A amostra incluiu 16 estudos e a qualidade metodológica foi avaliada utilizando as ferramentas do JBI. Registrado protocolo no Open Science Framework, disponível em https://doi.org/10.17605/OSF.IO/NKMZB. Resultados: tempo no alvo (70-180 mg/dl) apresentou correlação negativa com a hemoglobina glicada, enquanto o tempo acima do alvo (>180 mg/dl) mostrou correlação positiva. Os coeficientes de correlação variaram entre -0,310 e -0,869 para o tempo no alvo, e entre 0,66 e 0,934 para o tempo acima do alvo. Um estudo foi efetuado com população que realizava a automonitorização. Conclusão: há correlação estatisticamente significativa entre o tempo no alvo e o tempo acima do alvo com a hemoglobina glicada. Quanto maior a proporção na faixa glicêmica adequada, mais próxima ou inferior a 7% estará a hemoglobina glicada. São necessários mais estudos que avaliem essa métrica com dados da automonitorização da glicemia.

Enhanced Recovery after Surgery Applied to Pediatric Laparoscopic Cholecystectomy for Simple Cholelithiasis: Feasibility and Teaching Insights.

BACKGROUND: Same-day discharge after a cholecystectomy is a common practice in the adult population and has been demonstrated as safe and viable for children as well. However, there is a lack of comprehensive teaching models for pediatric cholecystectomy. Drawing inspiration from standardized outpatient procedures, this study aimed to assess the clinical outcomes and feasibility of teaching programs and an Enhanced Recovery After Surgery (ERAS) protocol following ambulatory laparoscopic cholecystectomy in pediatric patients. METHODS: In 2015, an ERAS pathway for laparoscopic cholecystectomy (LC) was implemented, focusing on admission procedures, surgery timing, anesthetic choices, analgesia, postoperative feeding, mobilization, and pain assessment. Day-case surgery was not applicable for acute cholecystitis, choledochal lithiasis, sickle cell disease, and hereditary spherocytosis cases. The protocol was employed for a group of attending surgeons and fellows, as well as a group of residents under the supervision of experienced surgeons. A retrospective analysis was conducted to evaluate the feasibility and effectiveness of ambulatory cholecystectomy in children and its utilization in training pediatric surgical trainees. RESULTS: Between 2015 and 2020, a total of 33 patients were included from a cohort of 162 children who underwent LC, with 15 children operated on by senior surgeons and 18 by young surgeons. The primary diagnoses were symptomatic gallbladder lithiasis (n = 32) and biliary dyskinesia (n = 1). The median age at the time of surgery was 11.3 years (interquartile range (IQR) 4.9-18), and the median duration of surgery was 54 min (IQR 13-145). One intraoperative complication occurred, involving gallbladder rupture and the dissemination of lithiasis into the peritoneal cavity. Three patients (9%) required an overnight stay, while no postoperative complications or readmissions within 30 days were observed. ERAS was successfully implemented in 30 patients (91%). No significant differences in surgical outcomes were noted between senior and young surgeons. At an average follow-up of 55 months, no long-term sequelae were identified. CONCLUSIONS: These findings align with the current trend of increasing use of outpatient laparoscopic cholecystectomy and underscore its feasibility in the pediatric population. The application of a structured ERAS protocol appears viable and practical for training the next generation of pediatric surgeons. LEVEL OF EVIDENCE: Level III.

Leishmania braziliensis exosomes activate human macrophages to produce proinflammatory mediators.

Exosomes, organelles measuring 30-200nm, are secreted by various cell types. Leishmania exosomes consist of many proteins, including heat shock proteins, annexins, Glycoprotein 63, proteins exerting signaling activity and those containing mRNA and miRNA. Studies have demonstrated that Leishmania donovani exosomes downregulate IFN-γ and inhibit the expression of microbicidal molecules, such as TNF and nitric oxide, thus creating a microenvironment favoring parasite proliferation. Despite lacking immunological memory, data in the literature suggest that, following initial stimulation, mononuclear phagocytes may become "trained" to respond more effectively to subsequent stimuli. Here we characterized the effects of macrophage sensitization using L. braziliensis exosomes prior to infection by the same pathogen. Human macrophages were stimulated with L. braziliensis exosomes and then infected with L. braziliensis. Higher levels of IL-1ß and IL-6 were detected in cultures sensitized prior to infection compared to unstimulated infected cells. Moreover, stimulation with L. braziliensis exosomes induced macrophage production of IL-1ß, IL-6, IL-10 and TNF. Inhibition of exosome secretion by L. braziliensis prior to macrophage infection reduced cytokine production and produced lower infection rates than untreated infected cells. Exosome stimulation also induced the consumption/regulation of NLRP3 inflammasome components in macrophages, while the blockade of NLRP3 resulted in lower levels of IL-6 and IL-1ß. Our results suggest that L. braziliensis exosomes stimulate macrophages, leading to an exacerbated inflammatory state that may be NLRP3-dependent.

Laparoscopy-assisted percutaneous correction of abdominal wall defects in the umbilical region in a cadaveric model of bovine fetus.

Abdominal wall defects in calves are commonly diagnosed and treated via laparotomy. This technique has witnessed several advancements in the management of these disorders. This study aimed to create a study model and evaluate the feasibility of video-assisted percutaneous correction of abdominal wall defects in bovine fetuses (corpses) compared with the conventional technique. Sixteen bovine fetuses from pregnant cows slaughtered in slaughterhouses were included in this study. The fetuses were categorized into the control group (CG, n = 8), which was subjected to umbilical abdominorrhaphy via laparotomy, and the video-surgical group (VG, n = 8), which received video-assisted percutaneous sutures with two lateral accesses on the right flank. An abdominal wall defect was created in the VG group to generate a study model, which was corrected using the laparoscopic technique. The procedures were performed in two steps. The first step consisted of creating an abdominal wall defect in the umbilical region by laparoscopic approach in an iatrogenic manner (Step 1: E1). The second stage consisted of conventional abdominorrhaphy of the umbilical region wall defect in the CG group and video-assisted percutaneous suturing of the edges of the iatrogenic abdominal wall defect in the VG group, until reversal of the laparoscopic accesses (Step 2: E2). Step 1 showed no statistically significant difference between the two groups. However, a significant statistical difference (p < 0.0001) was observed between the two groups in step 2. The surgical time of step 2 was longer in the CG group (33.10 ± 0.43 minutes) than that in the VG group (10.13 ± 0.68 minutes, p < 0.0001), and the total surgical time was also longer in the CG group (38.48 ± 0.35 minutes) than that in the VG group (15.86 ± 0.67 minutes). The proposed laparoscopic technique allowed the creation of a study model for video-assisted percutaneous suturing with two portals and reduced the surgical time compared with the conventional technique. However, this method needs to be studied further in live animals.

Thoracoscopic lobectomy for congenital pulmonary airway malformations before or after 5 months of age: evaluation of pulmonary function.

BACKGROUND: Congenital pulmonary airway malformation (CPAM) is the most common pulmonary malformation. It can be managed via thoracoscopic lobectomy, which is safe and advantageous over thoracotomy. Some authors advocate the need for early resection to get an advantage over lung growth. Our study aimed to evaluate and compare the pulmonary function in patients who underwent thoracoscopic lobectomy for CPAM before and after 5 months of age. METHODS: This retrospective study was conducted between 2007 and 2014. Patients younger than 5 months were assigned to group 1 and those over 5 months of age were assigned to group 2. Pulmonary function tests (PFT) were requested for all the included patients. For patients who could not undergo full PFT, the function residual capacity (FRC) was evaluated by the helium dilution technique. The parameters evaluated in full PFT were forced expiratory volume in one second (FEV1), forced vital capacity (FVC), total lung capacity (TLC), and FEV1 to FVC ratio (FEV1/FVC). The Mann Whitney U test was used to compare both groups of patients. RESULTS: Seventy patients underwent thoracoscopic lobectomy during this period, 40 of which had CPAM. Twenty-seven patients tolerated and underwent PFT (group 1: 12 patients; group 2: 15 patients). Among them, 16 patients underwent full PFT and 11 patients had FRC measurement. FRC was similar in both groups (91% vs. 88.2%). FEV1 (83.9% vs. 86.4%), FVC (86.8% vs. 92.6%) and TLC (86.5% vs. 87.8%) were also similar between both groups. FEV1/FVC was slightly higher in group 1 (97.9% vs. 89.4%) but the difference was not statistically significant. CONCLUSIONS: PFT for patients who underwent thoracoscopic lobectomy for CPAM before or after 5 months of age is normal and comparable between both groups. Surgical resection of CPAM can be performed safely early in life without any consequences for pulmonary function or more complications when older children undergo surgery.

Inventory of Interpersonal Problems-Personality Disorders: adaptation to Brazil and test of a bifactor model

Objective: The Inventory of Interpersonal Problems-Personality Disorders (IIP-PD-47) has a controversial factor structure, as some studies have provided support for 5 correlated factors, and others have suggested the existence of a general second-order dimension. One approach of data modelling that reconciles multidimensionality and the existence of a general factor is the bifactor analysis. We used unrestricted exploratory-confirmatory bifactor modelling to validate the Brazilian version of the IIP-PD-47. Methods: The sample consisted of 1,091 subjects aged 18-64 years who answered the IIP-PD-47 and a collateral measure of pathological traits, the Dimensional Clinical Personality Inventory 2 (IDCP-2). Results: After testing many candidate models, our data were best represented by a bifactor model with one general factor and five specific uncorrelated factors. Nevertheless, a closer inspection of the discriminant validity of each IIP-PD-47 factor revealed strong support for the general factor and a factor capturing aggressive behaviours, but less support for the additional four specific factors. Conclusions: The theoretical and practical implications of these findings are discussed, and some recommendations are offered about the need for controlling response styles when assessing PD traits via self-report inventories. Our findings indicate that the Brazilian version of IIP-PD has promising psychometric properties.

Objetivo: El Inventario de Problemas Interpersonales-Trastornos de la Personalidad (IIP-PD-47) tiene una estructura factorial controvertida, ya que algunos estudios han apoyado 5 factores correlacionados y otros han sen˜ alado la existencia de una dimensión general de segundo orden. Un enfoque del modelado de datos que concilia la multidimensionalidad y la existencia de un factor general es el análisis de bifactores. Para validar la versión brasileña del IIP-PD-47, se utilizó un modelo bifactorial confirmatorio exploratorio sin restricciones. Métodos: La muestra incluyó a 1.091 sujetos de 18 a 64 anos que respondieron al IIP-PD-47 y una medida colateral de rasgos patológicos, el Inventario de Personalidad Clínica Dimensional 2 (IDCP-2). Resultados: Después de probar muchos modelos candidatos, nuestros datos se representaron mejor mediante un modelo bifactorial con 1 factor general y 5 factores específicos no correlacionados. Sin embargo, una inspección más cercana de la validez discriminante de cada factor IIP-PD-47 reveló un fuerte respaldo del factor general y un factor que capta comportamientos agresivos, pero menos respaldo a los 4 factores específicos adicionales. Conclusiones: Se discuten las implicaciones teóricas y prácticas de estos hallazgos y se ofrecen algunas recomendaciones sobre la necesidad de controlar los estilos de respuesta al evaluar los rasgos de la EP a través de inventarios de autoaplicados. Nuestros hallazgos indican que la versión brasileña de IIP-PD tiene propiedades psicométricas prometedoras.

Acesso a um serviço de saúde público especializado: experiência no centro de referência de doença trofoblástica gestacional do Hospital São Paulo / Accessing a specialized public health service: the São Paulo Hospital reference center for gestational trophoblastic diseases

Objetivo: Analisar a trajetória das mulheres com doença trofoblástica gestacional (DTG) até o Centro de Referência de Doença Trofoblástica Gestacional do Hospital São Paulo (CRDTG-HSP), identificando as portas de entrada ao serviço e as dificuldades que elas enfrentaram desde o diagnóstico. Métodos: Estudo de caso transversal exploratório, descritivo-analítico, com abordagem quali-quantitativa, que incluiu pacientes atendidas no período de 2015 a 2018. A coleta dos dados se deu por meio de um questionário on-line e de uma entrevista com roteiro semiestruturado. Resultados: Entre 96 pacientes, 40,63% (n = 39) tiveram acesso ao CRDTG-HSP por encaminhamento entre médicos, 31,25% (n = 30), pela página do Facebook da Associação Brasileira de Doença Trofoblástica Gestacional e 10,42% (n = 10), por meio da central de regulação de vagas do estado de São Paulo (CROSS), das quais 28,2%, 73% e 30%, respectivamente, possuíam assistência privada, na qual receberam tratamento inicial. As 12 entrevistadas relataram dificuldades, tais como a percepção da falta de preparo médico no manejo e comunicação da doença, o desconhecimento da sua situação de saúde mesmo após procedimentos cirúrgicos, a exposição a conversas inapropriadas entre médicos sobre o seu caso e o recebimento de encaminhamento sem explicação esclarecedora sobre seu quadro clínico. Por fim, as pacientes avaliaram positivamente a utilização de e-mail e WhatsApp como facilitadores no atendimento no CRDTG-HSP. Conclusão: O acesso ao CRDTG-HSP ocorreu minoritariamente pela CROSS e, mesmo tendo assistência privada, pacientes migraram para atendimento no centro especializado. Além disso, as pacientes tiveram percepção de falta de preparo médico no atendimento da DTG fora do CRDTG.(AU)

Objective: To understand and elaborate the trajectories of women with gestational trophoblastic disease from the initial entry to the healthcare system to follow-up at a public tertiary reference center. Methods: This exploratory, descriptive-analytical, cross-sectional case study included patients from 2015 to 2018. The data collected through online questionnaires and semi-structured interviews were analyzed via quantitative and qualitative approaches. Statistical analysis was performed using Pearson's chi-square test at 5% significance using software R version 4.0.2. The test power for the sample was calculated using G*power software version 3.1.9.6. Results: Overall, 96 patients completed the questionnaire. Only 10(10.42%) patients reached the reference center through the official channel, Sao Paulo State Vacancy Regulation Center, while 39(40.63%) patients through referral from physicians, and 30(31.25%) patients through the Brazilian Association of Gestational Trophoblastic Disease's Facebook fan page. Overall, 36 patients (37.5%) had private insurance and 73% of patients who reached the reference center via Facebook had private insurance. Twelve participants were interviewed and reported barriers, such as difficulties in understanding their health issues prior to arrival at the reference center, lack of professional knowledge about the disease, poor communication, and exposure to inappropriate conversations. They positively evaluated the reference center, the interaction was facilitated using email and WhatsApp. Conclusion: Although appropriate public care for these women exists, the flow from the diagnosis to specialized treatment remains unclear for both professionals and patients. The participants perceived that communication and physicians' expertise were inadequate.(AU)

Antifungal Annona muricata L. (soursop) extract targets the cell envelope of multi-drug resistant Candida albicans.

ETNOPHARMACOLOGICAL RELEVANCE: Annona muricata L. (soursop) is traditionally used in the treatment of inflammatory diseases, cancer, and infections caused by fungi. The therapeutic activity explored by its medicinal use is generally associated with its phytoconstituents, such as acetogenins and alkaloids. However, its potential antifungal bioactivity as well as its mechanism of action remains to be established. AIM OF THE STUDY: To evaluate the antifungal activity of the ethanolic extract of A. muricata leaves against multidrug-resistant Candida albicans (ATCC® 10231). MATERIAL AND METHODS: Phytoconstituents were detected by UFLC-QTOF-MS. The minimum inhibitory concentration was determined, followed by the determination of the minimum fungicidal concentration. For planktonic cells, the growth curve and cell density were evaluated. Studies to understand the mechanism of action on the cell envelope involved crystal violet permeability, membrane extravasation, sorbitol protection, exogenous ergosterol binding assay, metabolic activity, and cell viability. Furthermore, mitochondrial membrane potential was assessed. RESULTS: Our analyses demonstrated a significant inhibitory effect of A. muricata, with the ability to reduce fungal growth by 58% and cell density by 65%. The extract affected both the fungal plasma membrane and cell wall integrity, with significant reduction of the cell viability. Depolarization of the fungal mitochondrial membrane was observed after treatment with A. muricata. Rutin, xi-anomuricine, kaempferol-3O-rutinoside, nornuciferine, xylopine, atherosperminine, caffeic acid, asimilobine, s-norcorydine, loliolide, annohexocin, annomuricin, annopentocin, and sucrose were identified as extract bioactive components. CONCLUSIONS: Our findings show that the A. muricata extract is a source of chemical diversity, which acts as a potential antifungal agent with promising application to the therapy of infections caused by C. albicans.

Teaching differential diagnosis with Anakin Skywalker: the duel between borderline personality disorder and bipolar disorder / Ensinando diagnóstico diferencial com Anakin Skywalker: o duelo entre transtorno da personalidade borderline e transtorno bipolar

Objective: Previous publications have focused on a leading pop culture phenomenon, Star Wars, to teach several issues in psychiatry, which can make understanding challenging themes easier. This article delves into matters of differential diagnoses regarding two psychiatric disorders. Methods: We examine and compare the symptoms and specificities of borderline personality disorder and bipolar disorder in the light of the fictional villain of the films, Darth Vader/Anakin Skywalker. Results and Conclusion: Our considerations of his diagnosis should be interpreted as an academic exercise with two main goals: to discuss the differential diagnosis between borderline personality disorder and bipolar disorder in an illustrative, soft, and ludic way; and to teach how to connect one's behaviors with diagnostic criteria - in this case, those related to borderline personality disorder.

Objetivo: Publicações de outrora utilizaram um dos principais fenômenos da cultura pop, Star Wars, para ensinar diversas questões sobre psiquiatria, demonstrando que usar os filmes da série para ensinar tais assuntos pode facilitar a compreensão de temas desafiadores. O objetivo deste artigo é aprofundar as questões do diagnóstico diferencial de dois transtornos psiquiátricos. Métodos: Nós examinamos e comparamos as especificidades do transtorno de personalidade borderline e transtorno bipolar à luz do personagem fictício dos filmes Star Wars, o vilão Darth Vader/Anakin Skywalker. Resultados e Conclusão: As considerações sobre o diagnóstico de Darth Vader devem ser interpretadas como um exercício acadêmico com dois objetivos principais: discutir o diagnóstico diferencial entre transtorno de personalidade borderline e transtorno bipolar de forma ilustrativa, suave e lúdica; e ensinar como relacionar os comportamentos com critérios diagnósticos, neste caso, especificamente relacionados ao transtorno de personalidade borderline.

A relação entre arte e vida em vigotski: uma análise conceitual / The relationship between art and life in vygotsky: a conceptual analysis / La relación entre arte y vida en vigotski: un análisis conceptual

Este trabalho teve como objetivo analisar a relação entre arte e vida segundo Vigotski. Para isso, foi realizada uma análise conceitual dos capítulos 1, 7, 9, 10 e 11 da Psicologia da Arte, do capítulo 13 da Psicologia Pedagógica e do texto O significado histórico da crise da Psicologia: Uma investigação metodológica. A pesquisa conceitual consiste na análise semântica dos principais conceitos de uma teoria com o intuito de elucidar seus sentidos ocultos ou confusos e desvendar possíveis contradições e ambiguidades no quadro teórico. Podemos observar que a arte é um fenômeno dialético tanto em sua criação como em seus efeitos. A influência da vida, isto é, da realidade sócio-histórica, na criação artística é indireta, pois ela é sempre mediada pelo psiquismo particular do artista. Já o efeito da arte sobre a vida possibilita que o ser humano se conscientize de sua realidade social e se engaje para mudá-la. A arte é, portanto, transformadora, pois reorganiza o psiquismo e possibilita uma mudança nas condições materiais dos seres humanos.(AU)

This study aims to analyze the relationship between art and life according to Vygotsky. Therefore, a conceptual analysis of chapters 1, 7, 9, 10, and 11 of Psychology of Art, chapter 13 of Educational Psychology and the text The Historical meaning of the Crisis of Psychology: A Methodological Investigation was carried out. Conceptual research consists of the semantic analysis of the main concepts of a theory to elucidate its hidden or confused meanings and to reveal possible contradictions and ambiguities in the theoretical framework. Results show that art is a dialectical phenomenon both in its creation and its effects. The influence of life, that is, of socio-historical reality, on artistic creation is indirect since it is always mediated by the artist's particular psyche. The effect of art on life, on the other hand, allows human beings to become aware of their social reality and engage to change it. Art is, therefore, transformative, as it reorganizes the psyche and enables a change in the material conditions of human beings.(AU)

Este proyecto tuve como objetivo analizar la relación entre el arte y la vida, según Vigotski. Para esto, fue realizado un análisis de los capítulos 1, 7, 9, 10 y 11 de Psicología del arte, del capítulo 13 de Psicología Pedagógica y del texto Él significado histórico de la crisis de la Psicología: una investigación metodológica. La pesquisa conceptual consiste en la analice semántica de los conceptos de una teoría, para aclarar sus significados ocultos o confusos y desvendar contradicciones y ambigüedades em el cuadro teórico. Pudimos observar que, el arte es un fenómeno dialéctico en su creación tanto como en sus efectos. La influencia de la vida, esto es, de la realidad socio-histórica, en la creación artística es indirecta, pues es mediada por el psiquismo particular de lo artista. Así, el efecto del arte sobre la vida habilita que lo ser humano adquiera conciencia de su realidad social y que se comprometa a cambiarla. El arte, consiguientemente, transformadora, pues reorganiza lo psiquismo y habilita un cambio en las condiciones materiales de los seres humanos.(AU)

Brain-derived neurotrophic factor serum levels following ketamine and esketamine intervention for treatment-resistant depression: secondary analysis from a randomized trial

Abstract Objectives Evidence suggests that ketamine's influence on brain-derived neurotrophic factor (BDNF) might be involved in its mechanism of rapid antidepressant action. We aimed to evaluate the differential impact of ketamine and esketamine on serum BDNF levels and its association with response patterns in treatment-resistant depression (TRD). Methods Participants (n = 53) are from a randomized, double-blind clinical trial comparing the efficacy of single-dose ketamine (0.5mg/kg, n = 27) and esketamine (0.25mg/kg, n = 26) in TRD. Depression severity was assessed before and 24 hours, 72 hours, and 7 days after the intervention, using the Montgomery-Åsberg Depression Rating Scale (MADRS). Blood samples were collected before infusion, 24 hours, and 7 days afterwards. Results There were no significant changes in BDNF levels at post-infusion evaluation points, and no difference in BDNF levels comparing ketamine and esketamine. Both drugs exhibited similar therapeutic effect. There was no association between BDNF levels and response to treatment or severity of depressive symptoms. Conclusion There was no significant treatment impact on BDNF serum levels - neither with ketamine nor esketamine - despite therapeutic response. These results suggest that ketamine or esketamine intervention for TRD has no impact on BDNF levels measured at 24 hours and 7 days after the infusion. This clinical trial is registered on the Japan Primary Registries Network: UMIN000032355.

Sociodemographic Profile of Acute Myocardial Infarction in Rio De Janeiro, Brazil (2010-2019)

Abstract Background Cardiovascular Diseases (CVDs) are the main cause of mortality in Brazil, which includes acute myocardial infarction (AMI). In 2017, 12% of deaths caused by infarction in Brazil occurred in the state of Rio de Janeiro, characterizing it as an important "hotspot" in the country. Objectives This study aimed to characterize the population affected by AMI over the past decade within the state so as to guide future public policies related to CVDs. Methods Secondary data of patients affected by AMI between 2010 and 2019 were obtained by DATASUS. In-hospital case-fatality rates, mortality rates, and proportional mortality were calculated using information gathered by the Mortality Information System (SIM) and demographic statistics produced by the Brazilian Institute of Geography and Statistics (IBGE). Results The main results showed that in-hospital case-fatality rates were higher in women, patients aged 60 years and over, the black color/race, and the state's Northwest region. The mortality rate was higher among men, especially in the South-central region and those over 50 years of age. People aged 40-49 years presented a considerable risk of death by infarction. The major categories of data classified as "ignored" in hospital admissions and death certificates were those related to race and education level. Conclusions Prevention should not only focus on the elderly, but also on people over 40, especially men. The incompleteness of electronic public data systems can affect the use of race/color or education level as epidemiological variables. New studies should be conducted to understand why the South-central region is so heavily affected by infarction.

Pandemia da Covid-19: um evento traumático para estudantes de Ciências Biológicas e da Saúde? / The Covid-19 pandemic: a traumatic event for health and biological science students?

Resumo: Introdução: Os universitários de Ciências da Saúde se tornaram especialmente afetados pela pandemia do vírus Sars-CoV-2. As angústias intrinsicamente relacionadas à Covid-19 foram somadas aos impactos referentes às mudanças acontecidas nas instituições acadêmicas, particularmente a mudança para o ensino on-line, uma metodologia que pode gerar desconforto aos estudantes, além de vários obstáculos relacionados ao ensino e à aprendizagem, o que pode ter repercussões traumáticas importantes na saúde mental dessa população. Objetivo: Este estudo teve como objetivo verificar a carga mental provocada pela pandemia da Covid-19, como um evento traumático ao ponto de desencadear transtornos psiquiátricos, como o transtorno do estresse pós-traumático (Tept), em universitários. Método: Trata-se de um estudo transversal e quantitativo, com orientação analítico-descritiva, mediante preenchimento de formulário digital anônimo, iniciado após prévia aprovação do Comitê de Ética em Pesquisa. Os sujeitos foram estudantes de Ciências Biológicas e da Saúde de uma universidade estadual localizada na Região Sudeste do Brasil. A amostra foi constituída por 618 estudantes. Resultado: Foram respondidos 618 formulários pelos estudantes que pertenciam aos cursos de Educação Física (28,8%), Medicina (25,4%), Odontologia (18,1%), Ciências Biológicas (15,2%) e Enfermagem (12,5%). A presença de sintomas de estresse pós-traumático verificados pela Escala de Impacto do Evento-Revisada (IES-R) obteve prevalência de 32,7% (n = 202) entre os estudantes universitários das Ciências Biológicas e da Saúde. Conclusão: Houve impacto significativo na saúde mental dos universitários com presença de sintomas depressivos, ansiedade e estresse acima dos encontrados na literatura científica, e, consequentemente, constatou-se alta na prevalência do Tept.

Abstract: Introduction: Health Sciences university students were especially affected by the Sars-CoV-2 virus pandemic. The anxieties intrinsically related to Covid-19 were added to the impacts related to the changes that have taken place in academic institutions, particularly the change to online teaching, a methodology that can generate discomfort for students, in addition to several obstacles related to teaching and learning, which can have important traumatic effects on the mental health of this population. Objective: To assess the mental health burden caused by the COVID-19 pandemic, as a traumatic event capable of triggering psychiatric disorders, such as Post-Traumatic Stress Disorder (PTSD), in university students. Methods: This is a cross-sectional and quantitative study, of analytical-descriptive nature, carried out by filling out an anonymous digital form, initiated after prior approval by the Research Ethics Committee. The subjects were students of Biological and Health Sciences at a State University located in the southeastern region of Brazil. The sample consisted of 618 students. Results: 618 forms were answered by students attending the courses of Physical Education (28.8%), Medicine (25.4%), Dentistry (18.1%), Biological Sciences (15.2%) and Nursing (12.5%). The presence of post-traumatic stress symptoms assessed by the Impact of Event Scale - Revised (IES-R) obtained a prevalence of 32.7% (n = 202) among university students from Biological and Health Sciences courses. Conclusions: There was a significant impact on the mental health of university students, with the presence of depressive symptoms, anxiety and stress above those found in the scientific literature and, consequently, a high prevalence of PTSD.

Impactos da percepção comunicacional e da timidez autorreferidos na avaliação ao falar em público de estudantes universitários / Impacts of self-reported communication perception and shyness on the public speaking assessment of university students

RESUMO Objetivo comparar a autoavaliação ao falar em público, por meio da Escala para Autoavaliação ao Falar em Público, com a percepção comunicacional e timidez autorreferidos, de estudantes universitários. Método tratou-se de um estudo observacional transversal prospectivo. Foram convidados a participar deste estudo, estudantes universitários do Brasil de diferentes áreas de conhecimento, sendo incluídos os que assentiram em participar. Os participantes receberam convite eletrônico e preencheram um formulário elaborado na plataforma Google Forms que continha questões sociodemográficas, sobre autopercepção como bom falante, sobre facilidade para se expressar, sobre timidez, e a Escala para Autoavaliação ao Falar em Público. Foram comparadas as médias da Escala de Autoavaliação ao Falar em Público com a autopercepção como bom falante, com a facilidade para se expressar e com a timidez. Resultados os participantes que se consideravam bons comunicadores, os que acreditavam ter facilidade para se expressar e os que não eram tímidos apresentaram melhor autopercepção sobre as suas habilidades de fala em público. Conclusão a autopercepção comunicacional positiva, bem como a autopercepção de menor timidez estão relacionadas a uma autoavaliação mais favorável em relação a apresentações em público.

ABSTRACT Purpose To compare self-assessment when speaking in public, using the Self-Statements During Public Speaking scale, with the communicational perception and self-reported shyness of university students. Methods This was a prospective cross-sectional observational study. University students from different areas of knowledge in Brazil were invited to participate in this study. Those who agreed to participate were included. Participants received an electronic invitation and filled out a form created on the Google Forms platform that contained sociodemographic questions, on self-perception as a good speaker, on ease of expression, on shyness, and the Self-Statements During Public Speaking scale. The means of the Self-Statements During Public Speaking scale were compared with the self-perception as a good speaker, the ease of expressing oneself, and shyness. Results Participants who considered themselves to be good communicators, those who believed they had an ease to express themselves, and those who were not shy had better self-perception of their public speaking skills. Conclusion positive communicational self-perception, as well as less shyness self-perception, are related to a more favorable self-assessment in relation to public presentations.

Toward Developing Clinical cut-off for the Grandiosity Scale of the Dimensional Clinical Personality Inventory 2 / Hacia el Desarrollo del Punto de Corte Clínico Para la Escala de Grandiosidad del Inventario Clínico Dimensional de Personalidad 2

ABSTRACT Objective: The present study aims to establish a clinical cut-off for the Grandiosity dimension, using item-level evaluation procedures. Methods: Participants were 5,387 adults, including outpatients diagnosed with narcissistic personality disorder (NPD), outpatients diagnosed with other personality disorders, and adults from the community. We administered the self-reported Grandiosity scale from the Dimensional Clinical Personality Inventory 2 (IDCP-2). The equating procedure was applied to generate theta scores for participants who did not answer all items. Results: The Wright map revealed that outpatients scored high on the latent continuum of the Grandiosity scale. Group comparison showed large effect sizes for the mean difference between patients and non-patients. The ROC curve supports a cut off at a -0.45 score in theta standardisation, which yields a high sensitivity (91%) and moderate specificity (58%). Moreover, the PPP (71%) and NPP (79%) values suggest that the scale is able to identify NPD patients in 71% of cases, and people without NPD in 79% of cases. Conclusions: The findings suggest the IDCP-2 Grandiosity scale is useful as an NPD screening tool. Possible clinical applications for the scale are described and the limitations of the study are discussed.

RESUMEN Objetivo: El presente estudio tiene como objetivo establecer un corte clínico para la dimensión Grandiosidad, utilizando procedimientos de evaluación a nivel de ítem. Métodos: Los participantes fueron 5.387 adultos, entre pacientes ambulatorios diagnosticados con trastorno de personalidad narcisista (NPD), pacientes ambulatorios diagnosticados con otros trastornos de la personalidad, y adultos de la comunidad. Se administró la escala de Grandiosidad autoinformada del Inventario Dimensional Clínico de Personalidad 2 (IDCP-2). El procedimiento de ecualización se aplicó para generar puntuaciones theta para los participantes que no respondieron a todos los ítems. Resultados: El mapa de Wright reveló que los pacientes ambulatorios estaban ubicados en los niveles altos en el continuo latente de la escala de Grandiosidad. La comparación grupal mostró tamaños de efecto grandes para la diferencia de medias entre pacientes y no pacientes. La curva ROC confirma un corte en -.45 puntos en la estandarización theta que produce una alta sensibilidad (91%) y una especificidad moderada (58%). Además, los valores de PPP (71%) y NPP (79%) indican que la escala puede identificar a los pacientes con NPD en el 71% de los casos y las personas sin NPD en el 79% de los casos. Conclusiones: Los resultados indican que la escala de Grandiosidad del IDCP-2 es útil como instrumento de evaluación para NPD. Se describen posibles aplicaciones clínicas para la escala y se discuten las limitaciones del estudio.

TNF-induced metalloproteinase-9 production is associated with neurological manifestations in HTLV-1-infected individuals.

HTLV-1-infected individuals may develop a neurologic inflammatory condition known as HTLV-1-associated myelopathy (HAM/TSP), in which the high production of TNF is observed. These patients exhibit higher proviral loads, enhanced production of proinflammatory cytokines and lymphocyte proliferation in comparison to asymptomatic HTLV-1 carriers and those presenting overactive bladder (OAB-HTLV-infected). Metalloproteinases (MMPs) are known to degrade the components of the blood-brain barrier, favoring the migration of infected cells into the central nervous system. Moreover, the unbalanced production of MMPs and their inhibitors (TIMPs) has also been associated with tissue damage. The present work studied the production of MMP-9 and TIMPs in HTLV-1-infected individuals with and without neurological manifestations. HAM/TSP patients presented higher concentrations of MMP-9 in peripheral blood mononuclear cell (PBMC) culture supernatants, as well as a higher MMP-9/TIMP-3 ratio when compared to the other groups studied. MMP-9 levels positively correlated with proviral load and TNF in OAB-HTLV-infected individuals, and the in vitro neutralization of TNF significantly decreased MMP-9 levels in PBMC culture supernatants. Our findings indicate an association between MMP-9 production and the proinflammatory state associated with HTLV-1 infection, as well as HAM/TSP.